Free Order - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

Document 503-2

Filed 01/13/2006

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

Table of Contents Juan F. v. Rell Exit Plan Quarterly Report July 1, 2005 ­ September 30, 2005 Page 2 4 6

Highlights Table 1 ­ Outcome Measures Overview Monitor's Additional Comments on the Status of Exit Plan Efforts Additional Monitor Reviews Appendix 1 - DCF Exit Plan Outcome Measures Summary Report Third Quarter 2005

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

Juan F. v. Rell Exit Plan Quarterly Report July 1, 2005 ­ September 30, 2005 Highlights 1. The Monitor's quarterly review of the Department of Children and Families (DCF) performance during the period of July through September 2005 indicates that focused work and steady progress has continued. The Department's efforts have resulted in an additional two (2) Exit Plan performance Outcome Measures being achieved during this period. Further, there is substantial evidence demonstrating the ongoing implementation of critical components related to all 22 Outcome Measures. 2. The Monitor's quarterly review of DCF for the period of July though September 2005 indicates that DCF has achieved compliance with ten (10) Outcome Measures. · Commencement of Investigations (96.2%) · Completion of Investigations (93.1%) · Maltreatment of Children in Out-of-Home Care (0.8%) · Reunification (64.2%) · Adoption (34.4%) · Sibling Placement (96.0%) · Multiple Placements (95.8%) · Foster Parent Training (100%) · Caseload Standards (99.8%)1 · Discharge Measures (95.0%) 3. The DCF has maintained compliance for at least two (2) consecutive quarters2 with six (6) of the Outcome Measures referenced above, namely: · Commencement of Investigations · Completion of Investigations · Maltreatment of Children in Out-of-Home Care · Multiple Placements · Caseload Standards · Foster Parent Training

The Monitor deemed the Department in compliance based upon the Monitor's review of the circumstances of two staff that exceeded the caseload standard by less than two days. See page 6 for further explanation. 2 Juan F. v. Rell Revised Exit Plan dated July 1, 2004, page 3, Intro 5..."The Defendants must be in compliance with all outcome measures, and in sustained compliance with all outcome measures for at least two quarters (six months) prior to asserting compliance and shall maintain compliance through any decision to terminate jurisdiction".

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

4. During the quarter under review, the DCF has achieved compliance with two (2) Outcome Measures with which they had not previously achieved compliance. · Reunification (64.2%) · Discharge Measures (95.0%) 5. The Monitor continues to have concerns related to the Department's ability to achieve substantial gains within the timeframe required by the Exit Plan in the following areas: · Treatment planning process (Outcome Measure 3) · Families' and children's needs met, especially the availability and quality of emergency placement services including but not limited to; shelters, safe homes and DCF facilities and the availability and quality of services required to transition children from emergency placement services including but not limited to; specialized foster care, therapeutic group homes, and community-based services (Outcome Measure 15). In addition, the Monitor will continue to closely review the Department's implementation of corrective steps for achieving the provision of MultiDisciplinary Exams (Outcome Measure 22). The Department's full unedited, but verified report to the Court Monitor is incorporated at the end of this Monitor's Report to the Court. Table 1, shows the DCF history of compliance for the past seven (7) quarters.

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________ 3Q Exit Plan Report (July 1-September 30, 2005)

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

1: Commencement of Investigation* 2: Completion of the Investigation 3: Treatment Plans** 4: Search for Relatives* 5: Repeat Maltreatment of InHome Children 6: Maltreatment of Children in Out-ofHome Care 7: Reunification* 8: Adoption 9: Transfer of Guardianship 10: Sibling Placement* 11: Re-Entry into DCF Custody* 12: Multiple Placements 13: Foster Parent Training 14: Placement Within Licensed Capacity 15: Children's Needs Met 16: Worker-Child Visitation (Out-ofHome)* 17: Worker-Child Visitation (InHome)* 18: Caseload Standards+ 19: Reduction in the Number of Children Placed in Residential Care 20: Discharge Measures 21: Discharge of Mentally Ill or Retarded Children 22: Multidisciplinary Exams (MDE)

>=90% >=85% >=90% >+85% <=7%

X 73.7% X 58% 9.3%

X 64.2% X 93% 9.4%

X 68.8% X 82% 8.9%

X 83.5% 10% 44.6% 9.4%

91.2% 91.7% 17% 49.2% 8.9%

92.5% 92.3% X 65.1% 8.2%

95.1% 92.3% X 2/15/06* 8.5%

96.2% 93.1% X 5/15/06* 9.1%

<=2% >=60% >=32% >=70% >=95% <=7% >=85% 100% >=96% >=80% >=85% 100%

1.2% 57.8% 12.5% 60.5% 57% 6.9% X X 94.9% X

0.5% X 10.7% 62.8% 65% X X X 88.3% 53%

0.8% X 11.1% 52.4% 53% X 95.8% 100% 92.0% 57%

0.9% X 29.6% 64.6% X X 95.2% 100% 93.0% 53%

0.6% X 16.7% 63.3% X X 95.5% 100% 95.7% 56%

0.8% X 33% 64.0% X X 96.2% 100% 97% X

0.7% X 25.2% 72.8% X X 95.7% 100% 95.9% X

0.8% 64.2% 34.4% 64.3%* 96% 6.4% 95.8% 100% 94.8% X

Monthly- Monthly- Monthly- Monthly- Monthly 72% 86% 73% 81% 77.9% X Quarterly- Quarterly Quarterly- Quarterly- Quarterly 87% 98% 93% 91% 93.3% X 69.2% 39% 73.1% 40% 100% 46% 100% 33% 100% X 100%

Monthly Monthly 86.7% 83.3% Quarterly Quarterly 95.7% 92.8% 81.9% 100% 78.3% 99.80%

>=85% 100%

<=11%

13.5%

13.9%

14.3%

14.7%

13.9%

13.7%

12.6%

11.6%

>=85%

61%

74%

52%

93%

83%

X

X

96%

100%

X

43%

64%

56%

60%

X

X

78%

>=85%

5.6%

19.0%

24.5%

48.9%

44.7%

55.4%

52.1%

54.6%

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________
Results based on Case Reviews ****For 1Q and 2Q 2005 case reviews will not be conducted for outcome measures #: 3, 4, 15, 16, 17, 20 and 21.***** NOTE: Case reviews will continue to be conducted for two quarters following the LINK build (this will allow for a two quarter testing period). A LINK report will be conducted for the third quarter following the LINK Build. * Link report posted for 3Q 2005 reflecting status of children entering care for the 1Q 2005 period. This is consistent with the Exit Plan measure definition. Refer to 1Q 2005 column. OM LINK data via ROM report available for 3Q 2005. With a case review to supplement ROM report. For re-entry, the 7, 11 case review was not completed for 3Q 2005, this is not an official result. OM Case review. Under negotiations with Court Monitor for ROM reporting and supplemental case review. 10 Case reviews for 2/15/05 and 5/15/05. LINK Report available for 11/15/05. In addition, as of 3Q 2005 the Department OM will include the one visit per quarter results for OM 16. This method reports all children in care who had 1 (one) visit 16, during the quarter period. The LINK system is unable to determine if the visits were made by the assigned social 17 worker as indicated in the Exit Plan. OM 4 OM 8, 9 As of the 3Q 2005 the LINK report will include all n/a cases (unable to determine date of removal but who have achieved permanency either through adoption or transfer of guardianship) into the data results. Following are the results including the n/a: 1Q 2005 (OM 8- 23.3%; OM 9 ­ 50.0%) and 2Q 2005 (OM 8 ­ 30.2%; OM 9 ­ 48.0%). For 3Q 2005 results, 48 were n/a. A Case review was conducted to determine the status of these n/a cases. The Results show the following: Out of the 48 n/a ­ 14 met the goal, 8 did not meet the goal and 26 were non-applicable (children were never in foster care nor legally committed to DCF ­ these were cases where the TOG occurred between other parties). Therefore, we completed a total of 112 TOG for 3Q 2005 with 63.4% meeting the goal and 36.6% not meeting the goal.

OM 19 Our Department conducted a special effort to identify youth in subacute programs. They were removed, for the first time, from our overall residential list. This resulted in a reduction (of 16 youth) from11.8% to 11.6%. This is an effort that will continue for the remainder of the Exit Plan reporting periods.

Treatment Plans**
** Treatment Plans were evaluated based on four (4) major categories (including elements a-o): 2004 1Q Background Information (53%), Assessment Information (52%), Treatment Services (47%), and Progress Toward Case Goals (18%). (Approved and Not Approved treatment plans) 2Q Background Information (60%), Assessment Information (37%), Treatment Services (43%), and Progress Toward Case Goals (32%). (Approved and Not Approved treatment plans) 3Q Background Information (66%), Assessment Information (52%), Treatment Services (55%), and Progress Toward Case Goals (35%). (Approved treatment plans only ­ 86) 4Q Background Information (69%), Assessment Information (67%), Treatment Services (54%), and Progress Toward Case Goals (34%). (Approved treatment plans only ­ 86) 2005 1Q N/A 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). 2004 1Q Treatment Plan Written in the family's primary language n/a and Treatment Plan Conference conducted in the family's primary language (95%) 2Q Treatment Plan Written in the family's primary language (91%) and Treatment Plan Conference conducted in the family's primary language (98%) 3Q Treatment Plan Written in the family's primary language (89%) and Treatment Plan Conference conducted in the family's primary language (97%) 4Q Treatment Plan Written in the family's primary language (97%) and Treatment Plan Conference conducted in the family's primary language (100%) 2005 1Q N/A OM 3 and OM 15 - No LINK report expected. Case Review Only.

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

Monitor's Additional Comments on the Status of Exit Plan Efforts Update on DCF's Data Capabilities: Five years ago, the Department could not produce automated LINK reports. Rather, the Department produced ad hoc, manual reports by individual request. Today the Department produces a large number of routine daily, weekly, monthly and quarterly reports. These reports enable the Department to supervise and monitor service delivery and specific case practice issues in a variety of ways. The Department's latest efforts have resulted in the ability to provide automated reports for Outcome Measures 7 (Reunification) and 11 (Re-entry into DCF Custody). The Department has provided an automated report for Outcome Measure 7 (Reunification) for the first time this quarter. Given the issues raised in the Monitor's 2005 Annual Progress Report regarding data entry errors involving missing removal data, missing legal status information, and discharge data inaccuracies the Department conducted a case review to supplement the automated report. The Monitor has verified the data via a sampling of cases. The Department's initial automated report indicated that 205 of 321 (63.86%) of children met the Exit Plan measure. Upon case review, 48 children were found to have missing legal data. Upon accounting for the actual legal discharge dates, 14 children were removed from the quarterly universe and 34 were added. Ten additional children were added to the population once their removal date was determined. The net change to the population was 30 additional children, 23 of which met the measure and seven (7) did not. The adjusted number of children that met the measure was 228 of 351 (64.96%). In a similar manner the Department has provided an automated report on Outcome Measure 11 (Re-entry into DCF Custody). Given the timing of the implementation of this reporting function, a case review was not completed for the quarter under review. While the Monitor has approved and verified the logic to produce the report for this measure, accuracy of the report cannot be determined until the Department conducts a similar case review as done for Outcome Measure 7. The preliminary automated Third Quarter report for Outcome Measure 11 indicates a re-entry rate of 6.4%3. During the course of the next quarter, the Monitor hopes to approve the Department's reporting parameters and data logic for Outcome Measure 10 (Sibling Placement). The Department's automated report for Outcome Measure 16 (Worker/Child VisitationQuarterly, Out-of-Home) includes visits by all social work professionals. The measure requires children to be visited quarterly by a DCF social worker. The Department is unable to filter this report to include only DCF social workers. Thus, the results for this measure may be overstated. The Department's reported results would need to be verified via a comprehensive case review.
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The Exit Plan standard for Re-entry into DCF Custody (Outcome Measure 11) is <=7%.

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

Adoption (Outcome Measure 8): The Monitor's Annual Progress Report 2005 noted the marked improvement by the Department in meeting Outcome Measure 8 (Adoption). Overall, 34.4%4 of the adoptions finalized during the quarter were within 24 months of the child's entry into DCF custody. This marks the second time in three quarters that this measure has been achieved. For fiscal year 2005, the Department's LINK data indicates that there were 597 adoptions finalized and 189 subsidize guardianships granted for a total of 786 children placed in permanent homes. Considerable effort is still required to meet the needs of children for which foster and adoptive resources are required. The Department currently does not have enough licensed homes to apply the principles of matching in a consistent manner. The lack of sufficient placement resources impacts several measures including: multiple placements, needs met, and all of the permanency measures as the length of time in care can be extended due to of this deficiency. During November, which is National Adoption Month, the Department presented its Third Annual Heart Gallery at multiple sites throughout metropolitan areas of Connecticut. The Heart Gallery is an effort now undertaken in over 40 states to feature children in need of permanent homes. Most of the children featured in Connecticut have already had considerable efforts directed at finding permanent resources by both the Department and contracted providers without success. Through the collaboration of state and community partners, including local photographers, the youngsters' stories are told via the use of photographs and thoughtful descriptions. At the time of this report, 22 inquiries had been received regarding this year's featured children. The recently implemented Adoption Assistance Program that is administered by the University of Connecticut Health Center, offers assistance to adoptive families for a variety of issues or problems that are either directly or indirectly related to adoption. These issues include; childhood trauma, social/emotional and behavioral issues, attachment issues, stress or emotional problems, health management, drug or alcohol abuse or dependency, and financial and legal difficulties. The program has already had 31 contacts from adoptive families during the first three months of operation. Treatment Planning and Families and Children's Needs Met (Outcome Measures 3 and 15): The Monitor's 2005 Annual Progress Report detailed the deficiencies in the two areas of treatment planning and needs met. While the Department has taken steps to advance the treatment planning process by statewide training with a new treatment plan format, emphasizing family engagement and thorough assessments, improvement is slow. The changes outlined in the Department's training are significant system changes for both area office and facility staff. Change will not be achieved in a short-term fashion but
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The Exit Plan standard for Adoption (Outcome Measure 8) is 32%.

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

rather will require a long-term approach that offers ongoing support and supervision for staff. Despite the increased fiscal resources provided to the Department by the Governor and Legislature, clear service deficits remain that severely impact the states most vulnerable children. Available data indicates that there are hundreds of children whose placement and clinical service needs are not currently being met. Youngsters remain in shelters, residential programs, safe homes, DCF facilities and hospitals for extended periods of time waiting for an appropriate resource to be made available. In many parts of the state, wait lists for community services are also routine, and hinder the Department's ability to prevent removals or expedite the safe return of children to their families. The aggressive startup of therapeutic group homes has provided appropriate clinical resources for 55 children in 10 homes. Cohorts of children have been identified for the remaining 30 homes that are to be developed during the remainder of 2005 and 2006. These homes will serve 150 children. An additional 10 homes are to be built in 2007 to serve an additional 50 children. Despite the promise of quality care that therapeutic group homes hold for these identified children, hundreds of additional children have been identified as needing foster care resources or therapeutic group homes and they remain waiting for an appropriate resource to be located. For the Department to succeed in reducing the number of children who remain in more restrictive and intensive placement settings, timely and effective community services must be available in sufficient quantity and in a manner that provides "wraparound" services for children, families and foster families as they step down. Preventive services and services offered at the initial stage of DCF involvement must be readily available to assist children and families. The startup of additional in-home services as outlined in the current budget will provide added capacity to serve children and families but will not eliminate significant wait lists that exist for many services. The implementation of the Administrative Service Organization (ASO) in January 2006 is intended to integrate the administration of behavioral health services funded through DCF and Department of Social Services under Husky A, Husky B, and Voluntary Service Programs. This initiative will attempt to: · Reduce the fragmentation of service delivery, · Improve access to community services, · Coordinate and develop appropriate care for children with special behavioral needs and; · Measure system performance Caseload Standards (Outcome Measure 18): Two social workers out of a pool of over 1200 social workers exceeded the caseload standard by one day and two days respectively. While the Department did not technically meet the measure, the circumstances of such cases must also be reviewed. In these two cases, the decision to allow the workers to appropriately close a case without

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Case 2:89-cv-00859-AHN

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

unnecessarily transferring another case solely to meet the outcome measure was appropriate. Decisions to continue to service a case, close a case, or transfer a case are the constant paradoxes for a system seeking to provide quality case management and meet outcome standards. The decision to not transfer a case needlessly or close a case prematurely should always be the higher standard to which a system aspires. The Monitor, when analyzing data to determine compliance will always apply a case practice standard as well as a quantitative standard where such information is available. Residential Reduction (Outcome Measure 19): While the Department has not met Outcome Measure 19 (Residential Reduction) it's performance this quarter is worth noting. The achievement of 11.6%5 of the out of home population in residential care translates to a reduction of over 200 children in residential placement since April 2004 (when 889 children were in residential programs). More significant is the reduction in utilization of out-of-state residential programs. As of September 2005, there are approximately 200 fewer children (including adjudicated delinquents) in out-of-state programs than were in similar programs in November 2004. With this shift to meeting the needs of children in state, and when possible within the community setting, comes the responsibility of providing timely and effective placement, permanency and community services. The current waiting lists for many community services and lack of specialized placement resources hampers DCF's efforts to effectively meet children's needs. Discharge Measures (Outcome Measure 20) The measure requires that 85% of all children age 18 or older achieve one or more of the following goals before discharge from the Department's care: · Graduation from High School · Acquisition of a GED · Enrollment in or completion of college or other post secondary training program full-time · Enrollment in college or other post secondary training program part-time with part-time employment · Full-time employment · Enlistment full-time member of the military While the success rates for youth fluctuates (in part due to the timing of graduations and enrollments) the Department's performance this past quarter is significantly improved. This is the first time the Department has met this measure. The Department's case review, verified by the Monitor, indicates that 37 of the 39 youth (95%) exiting from care met this measure. Specifically, 18 of these youth graduated from high school, two earned their GED, and 17 met two requirements (high school or a GED and one other measure).

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The Exit Plan standard for Residential Reduction (Outcome Measure 19) is 11%.

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Case 2:89-cv-00859-AHN

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Filed 01/13/2006

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Monitor's Juan F. vs. Rell Quarterly Exit Plan Report December 28, 2005 _____________________________________________

Additional Monitor Reviews The Monitor has resumed random attendance at Administrative Case Reviews and Treatment Planning Conferences. The Monitor will then review the treatment plans that result from those reviews attended to determine the level of adequacy utilizing the current draft tool being tested by the Department. In addition, the Monitor is reviewing the treatment plans for compliance with Outcome Measure 15 (Needs Met). A quarterly report on these efforts will resume with the report produced for the time period October December 2005. This will be included with the quarterly report submitted by this office in February 2006. The Monitor has also completed a brief snapshot review of children in shelters, safe homes, and DCF facilities. We have focused on the children that have remained in a level of care for long lengths of time. This has provided additional insight into the barriers to achieving timely placement and/or services once discharge has been deemed appropriate. In early 2006, the Monitor will produce another in the series of longitudinal reports that details the progress of the cohort of 155 children with the stated goal of adoption on March 31, 2002. During January 2006, the Monitor will conduct a review of the use of flex funds. The sample will be selected from all requests made during the period of July through September 2005. At this juncture we are unable to report on the actual sample size, as the universe has not been provided by DCF. This review will attempt to make a determination of the impact of flex fund service provision for the family by looking at the current circumstances, as well as the presenting issues at the time service was provided.

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