Free Order - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

Document 524-2

Filed 09/11/2006

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Juan F. v. Rell Exit Plan Quarterly Report April 1, 2006 ­ June 30, 2006 Civil Action No. H-89-859 (AHN) September 11, 2006

Submitted by: DCF Court Monitor's Office 300 Church Street ~ 4th Floor Wallingford, CT 06492 Tel: 203-741-0458 Fax: 203-741-0462 E-Mail: [email protected]

Case 2:89-cv-00859-AHN

Document 524-2

Filed 09/11/2006

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

Table of Contents Juan F. v Rell Exit Plan Quarterly Report April 1, 2006 ­ June 30, 2006 Page Highlights New Methodology ­ Treatment Plan (Outcome Measure 3) and Needs Met (Outcome Measure 15) Reduction in Residential Care (Outcome Measure 19) Outcome Measure Overview Chart Appendix 1 ­ The Methodology for Outcome Measure 3 & 15 Appendix 2 ­ The Department's Exit Plan Outcome Measures Summary Report Second Quarter 2006 April 1, 2006 ­ June 30, 2006 3

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

Juan F. v Rell Exit Plan Quarterly Report April 1, 2006 ­ June 30, 2006 Highlights 1. The Monitor's quarterly review of the Department of Children and Families (DCF) efforts toward meeting the Exit Plan measures during the period April through June 2006 indicates that the Department has continued to sustain most of the achievements of previous quarters, and has for the first time met the important requirement for reducing the number of children placed in residential settings. 2. The Monitor's quarterly review of DCF for the period of April through June 2006 indicates that DCF has achieved compliance with a total of 15 measures. o Commencement of Investigation (96.4%) o Completion of Investigation (93.1%) o Search for Relatives (93.9%) o Repeat Maltreatment (7%) o Maltreatment of Children in Out-of-Home Care (0.7%) o Reunification (64.4%) o Adoption (36.9%) o Multiple Placements (96.6%) o Foster Parent Training (100%) o Worker-to-Child Visitation in Out-of-Home cases (86.5%) o Worker-to-Child Visitation in In-Home cases (87.6%) o Caseload Standards (100%) o Residential Reduction (10.8%) o Discharge Measures (91%) o Multi-Disciplinary Exams (89.9%) 3. DCF has maintained compliance for at least two (2) consecutive quarters1 with 14 of the Outcome Measures shown above (number of consecutive quarters indicated below): o Commencement of Investigations (seventh consecutive quarter) o Completion of Investigations (seventh consecutive quarter) o Search for Relatives (third consecutive quarter) o Repeat Maltreatment (second consecutive quarter) o Maltreatment of Children in Out-of-Home Care (tenth consecutive quarter) o Reunification (fourth consecutive quarter) o Adoption (second consecutive quarter) o Multiple Placements (ninth consecutive quarter) o Foster Parent Training (ninth consecutive quarter)
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The Defendants must be in compliance with all of the outcome measures, and in sustained compliance with all of the outcome measures for at least two consecutive quarters (six months) prior to asserting compliance and shall maintain compliance through any decision to terminate jurisdiction.

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

o Worker-to-Child Visitation in Out-of-Home Care (third consecutive quarter) o Worker to Child Visitation in In-Home Care (third consecutive quarter) o Caseload Standards (ninth consecutive quarter) o Discharge Measures (fourth consecutive quarter) o Multi-Disciplinary Exams (MDE) (second consecutive quarter) 4. DCF was not measured on Treatment Plans and Needs Met outcome measures during the period due to the methodological shift described later in this document. They did not attain compliance with Transfer of Guardianship2, Sibling Placement3, Placement within Licensed Capacity4, and Discharge of Mentally Ill or Retarded Children. Additionally, they were unable to maintain compliance with one measure that was first achieved last quarter: o Re-Entry to Care 5. DCF continues to be challenged to meet the placement and treatment needs for a number of children it serves. Hundreds of children remain in placement beyond the therapeutically indicated timeframe and wait-lists for essential community services continue to exist in many areas of the State despite the opening of new therapeutic group homes, the utilization of Managed Service Systems (MSS), the implementation of the Administrative Service Organization and additional community-based services. The Monitor's resumption of the review of Treatment Plans (Outcome Measure 3) and Needs Met (Outcome Measure 15) this quarter will assist in pinpointing areas of success and those needing improvement [see section New Methodology ­ Treatment Plan (Outcome Measure 3) and Needs Met (Outcome Measure 15) later in the report. 6. The Department's compliance with Outcome Measure 19 of the Exit Plan, Reduction in Residential Care, is an immense achievement. The Department considered this outcome measure one of the most difficult Exit Plan challenges. There are 250 fewer children currently placed in residential care than in the second quarter of 2004. Within this total, approximately 200 fewer children now receive residential treatment in out-of-state programs (see Reduction in Residential Care - Outcome Measure 19 later in the report). 7. The Monitor has continued to be involved in the ongoing program review at Riverview Hospital. The effectiveness and quality of both the State run programs and private provider network of programs and services must be continually reviewed and the resulting recommendations and action steps to improve the system must be implemented.

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Measure was previously attained in both the second and fourth quarters of 2005. Measure was previously attained in the third quarter of 2005. 4 Measure was previously attained in both the first and fourth quarters of 2005.

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

New Methodology ­ Treatment Plan (Outcome Measure 3) and Needs Met (Outcome Measure 15) On November 29, 2005 the Plaintiffs asserted that the Defendants were in actual or likely non-compliance with the following provisions of the Revised Exit Plan of July 1, 2004: · · · Outcome Measure 3 (Treatment Plans) Outcome Measure 15 (Children's Needs Met) Outcome Measure 22 (Multi-Disciplinary Exams)

As outlined in the Monitoring Order this triggered attempts at a negotiated solution. Beginning in December 2005, the parties to the Juan F. case began a series of meetings regarding OM 3 and OM15. The intent of these discussions was to explore an improved methodology for reviewing the key elements of the treatment plans (Outcome Measure 3) and the sufficiency in meeting children's and families' needs (Outcome Measure 15). The Monitor along with the parties to the case had a number of concerns with the original methodology for these two measures. The issues ranged from a lack of clarity and areas that were not sufficiently addressed in the original draft, to the rigidity of the requirements. The assistance of the Technical Advisory Committee (TAC) was consistently utilized throughout the process of revising the methodology. Following contemplation of a number of alternatives, the parties settled on an approach that was initially outlined in draft form by the Monitor in a March 2006 letter. This approach incorporated most of the key elements expressed by all parties and addressed the substantive concerns that were raised. The changes to the Exit Plan, and the incorporation of the new methodology for these measures were approved by the Honorable Judge Alan H. Nevas on July 11, 2006. The new methodology maintains the high standard for compliance but provides an opportunity for review of subtopics within each standard. The new methodology better defines each aspect of outcome measures 3 and 15 and allows for each measure to be analyzed separately and in greater detail than had previously been possible. The review of the permanency needs of children was clarified in this new approach. In addition, the revised methodology adds to the review and analysis a more qualitative process that includes a review of the record, the treatment plan and for the first time mandates the reviewer to attend the Treatment Planning Conference, Administrative Case Review, or Family Conference (when held) for both the in-home and child-in- placement cases selected for review. A qualitative review will provide better information about what is currently happening for children and families, and has the power to articulate and promote improvements in frontline practice and the organizational culture through regular feedback into the system. After testing the process in August and September with 35 cases, the review will consist of a sample of approximately 70 cases each quarter using a collaborative team of DCF and Court Monitor staff supervised by the Court

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

Monitor. Review staff have received initial training. The first full quarter that will be reviewed will be the fourth quarter: October through December 2006. The new approach to Outcome Measures 3 and 15 must also be viewed in context with enhancements to the comprehensive case review process being conducted by the Court Monitor for all 22 measures that will begin in late 2006 and continue through April 2007. The methodology for the remaining measures will involve conducting a verification of the agency LINK data, review of Chapin Hall reports, and a series of targeted reviews. These qualitative targeted reviews will utilize samples selected within the period of July through December 2006. This will provide the parties with data most relevant to the November 2006 Exit Plan deadline, while allowing the Department as much time as possible to benefit from the impact of recently implemented initiatives that are intended to improve case practice and outcome performance. By moving away from a single comprehensive case record review to several more targeted reviews, we will be able to attain more reliable information on qualitative issues that were previously measured by a review of an unacceptable small number of cases. As an additional result of the parties' ongoing negotiations over Plaintiffs' asserted noncompliance with outcome measures 3 and 15, the parties have agreed that the Court Monitor will begin reviewing, validating and providing the parties with a monthly set of reports on program areas within the broader context of meeting the service needs of children and families. This targeted reporting includes items such as: the number and age of children in SAFE Homes and emergency shelters, and the length of time they have been in custody, and the length of time they have been in those placements; monthly reports on the number of foster family homes, recruitment of new foster homes and any closing of foster family homes; and reports on the length of time children have been in DCF custody with identification of various steps to permanency. The format and Monitor's validation of these reports is still being finalized A copy of the methodology for Outcome Measure 3 and 15 is incorporated in this report as Appendix 1.

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

Reduction in Residential Care (Outcome Measure 19) The 2004 Exit Plan contains the provision that DCF will reduce the number of children placed in residential care5 less than or equal to 11% of the total number of Juan F. children in placement. This outcome measure is grounded in the belief that children should be placed in the least restrictive setting, preferably a family-based community placement. DCF has focused substantial amounts of time and resources to addressing the policy statement that underlies the measure. While the 11% figure is not a panacea for viewing ultimate success, it should be viewed as a target that will move the child welfare system in a new direction. The steps to achieving the measure have involved community placement alternatives and new models of care, additional in-home services, increased case-conferencing, coordinated discharge and placement efforts, development of standards of care, and public and private collaboration. Additional foster care alternatives and effective community-based services are still required to fulfill the promise of lasting system change. The Monitor has verified that during the second quarter DCF has achieved the measure with 10.8% of the out-of-home population in residential settings. As a result Outcome Measure 19 has been met for the first time. The Department's ability to sustain and improve on this effort will be tested over upcoming quarters, but this result represents a tremendous achievement by DCF and the private provider community. The 10.8% result translates into 652 children in residential care within the population of 6,045 Juan F. children in placement. In contrast the second quarter report for 2004 reported that 902 children were placed in residential and 6,287 Juan F. children were in placement overall. In two years, the Department has reduced the number placed in residential care by 250 children, or approximately 27%. In addition, the reduction of children placed out-of-state has been equally dramatic. There are almost 200 fewer children placed in out-of-state programs today, than were placed out-of-state two years ago. Of these, the majority of those placed out-of-state receive treatment services in Massachusetts (approximately 65%). Still, a significant number of children continue to wait for appropriate service and placement options on a daily basis. Waitlists for essential services are commonplace in many areas of the state and the lack of appropriate family-like placement resources means children spend months longer in restrictive levels of care. This is unacceptable for our most vulnerable children.

Residential facilities are 24-hour mental health facilities, which operate for the purpose of effecting positive change and normal growth and development for emotionally disturbed, behaviorally disordered and socially maladjusted youth. State operated facilities stand-alone group homes, Safe Homes, and juvenile justice 24-hour facilities are not included in this measure.

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________
2Q April 1-June 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

1: Commencement of Investigation* 2: Completion of the Investigation 3: Treatment Plans** 4: Search for Relatives* 5: Repeat Maltreatment 6: Maltreatment of Children in Out-ofHome 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 (Out-ofHome)* 17: Worker-Child Visitation (InHome)* 18: Caseload Standards+ 19: Reduction in Residential Care 20: Discharge Measures 21: Discharge of Mentally Ill or Retarded Children 22: Multidisciplinary Exams (MDE)

>=90% >=85% >=90% >=85% <=7% <=2%

X 73.7% X 58% 9.3% 1.2%

X 64.2% X 93% 9.4% 0.5%

X 68.8% X 82% 8.9% 0.8%

X 83.5% 10% 44.6% 9.4% 0.9%

91.2% 91.7% 17% 49.2% 8.9% 0.6%

92.5% 92.3% X 65.1% 8.2% 0.8%

95.1% 92.3% X 89.6% 8.5% 0.7%

96.2% 93.1% X 89.9% 9.1% 0.8%

96.1% 94.2% X 93.9% 7.3% 0.6%

96.2% 94.2% X 11/15/06* 6.3% 0.4%

96.4% 93.1% X 2/15/07* 7.0%

0.7% >=60% >=32% >=70% >=95% <=7% >=85% 100% >=96% 57.8% 12.5% 60.5% 57% 6.9% X X 94.9% X 10.7% 62.8% 65% X X X 88.3% X 11.1% 52.4% 53% X 95.8% 100% 92.0% X 29.6% 64.6% X X 95.2% 100% 93.0% X 16.7% 63.3% X X 95.5% 100% 95.7% X 33% 64.0% X X 96.2% 100% 97% X 25.2% 72.8% X X 95.7% 100% 95.9% 64.2% 34.4% 64.3%* 96% 7.2% 95.8% 100% 94.8% 61% 30.7% 72.4% 94% 7.6% 96% 100% 96.2% 66.4% 40.8% 60.7% 75% 6.7% 96.2% 100% 95.2% 94.5% >=80% X 53% 72% 87% 39% 57% 86% 98% 40% 53% 73% 93% 46% 56% 81% 91% 33% X 77.9% 93.3% X X 86.7% 95.7% 81.9% X 83.3% 92.8% 78.3% X 85.6% 91.9% 85.6% X 86.8% 93.1% 86.2% 87.6% 100% <=11% >=85% 100% 69.2% 13.5% 61% X 73.1% 13.9% 74% 43% 100% 14.3% 52% 64% 100% 14.7% 93% 56% 100% 13.9% 83% 60% 100% 13.7% X X 100% 12.6% X X 99.80% 11.8% 96% 78% 100% 11.6% 92% 70% 100% 11.3% 85% 95% 100% 10.8% 91% 97% X 86.5% 90.9% 64.4% 36.9% 63.1% 77% 7.5% 96.6% 100%

>=85% Monthly 100% Quarterly >=85% X

>=85%

5.6%

19.0%

24.5%

48.9%

44.7%

55.4%

52.1%

54.6%

72.1%

91.1%

89.9%

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

Appendix 1 The Methodology for Outcome Measure 3 & 15

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Monitor's Juan F. v. Rell Exit Plan Quarterly Report September 11, 2006 _____________________________________________

Appendix 2 The Department's Exit Plan Outcome Measures Summary Report Second Quarter 2006 April 1, 2006 ­ June 30, 2006

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