FLORIDA QA MANAGERS TRAINING, MARCH 14-15, 2011Selected Excerpts from QSR Training provided by The Child Welfare Policy and Practice Group

INTERVIEWING FUNDAMENTALS FOR THE QSR REVIEWERModeling the skills for building a trusting relationship

Core Conditions Reviewer Attributes.

Genuineness is “being you,” being congruent in what you say and do, being non-defensive and spontaneous. To be genuine you need to be aware of your feelings and at the same time respond to the family member (or other person being interviewed) in a respectful manner that opens up rather than closes communication. Genuineness helps to reduce the emotional distance between you and the person being interviewed.

Being yourself and balancing this with your professional role, and acting consistent with how you feel or believe

Making sure that your nonverbal behavior, voice tone and verbal responses match or are congruent

Communicating trustworthiness and acceptance

Being able to express yourself naturally without artificial behaviors

Being non-defensive Self-disclosing in a purposeful and

brief mannerRespect is believing that there is value in each human being and that there is potential in that person as well. There are two aspects of respect: 1) your attitude or value about people and 2) your ability to communicate respect in observable ways. Respect involves valuing the family member/person interviewed as a person separate from any evaluation of his/her behavior. Respect is recognizing the dignity and worth in each human being. When communicating respect, there is warmth that is conveyed to people that says you accept them, you like them, you care about them and you have concern for them. Respecting a person does not mean sanctioning or approving his/her thoughts or behaviors of which society may disapprove. Values and beliefs that convey respect include belief in the following: all human beings are worthy; each person is a unique individual; people have the right to self-determination, to make their own choices and people can change.

Scheduling the interview and being on time

Asking where to sit Addressing people formally

(e.g.Mr. Mrs.)Communicating warmth

Clarify how much time people have Explaining purpose of interview Being appreciative of interviewee’s

time and willingness Showing commitment to understand

their perspective; using good listening skills

Recognizing a person’s strengths Being open-minded and neutral

listener Using a person’s strengths

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Core Conditions Reviewer Attributes

Empathy is a process in which you attempt to experience another person’s world then communicate an understanding of and compassion for the person’s experience. You develop a sense of what the situation means to the other individual. Empathy is being able to see through another’s eyes and understand their worldview.

Recognizing the person’s experience, feelings and nonverbal communication

Communicating with words your understanding of the person’s experience.

Accurate empathy helps create a climate where the family member is willing and able to explore his/her issues and problems. Communicating with empathy results in more openness in people.

EXPLORING SKILLS

A ctive Listening and the Use of Reflections Listening is an active process which requires you to focus on what the family member is saying both in the content of his/her message and in the emotional process of his/her message. It is the most powerful interpersonal helping skill that promotes rapport and the building of a trusting and caring casework relationship. Active listening involves using both verbal and nonverbal messages to communicate your understanding of the family member’s experience. Your verbal response can focus on what the person is describing, how the person is feeling or both. You can reflect what the person is saying and/or reflect what the person is feeling. Active listening is used to empower families to explore and discuss topics. It conveys your understanding of their situation. It can help you gather certain information and it develops a broader and deeper understanding of the person’s circumstances.

Attending BehaviorsThese are behaviors that convey respect, acceptance and trust to family members. Following are two categories of attending behavior:

Physical attending is the intentional use of the environment and body to demonstrate respect for, acceptance and interest in the family member. You want to create a comfortable environment absent of distractions. You want to assure open communication by not placing any barriers between you and family members.

Psychological attending involves observing and listening to the family member and responding. It involves observing the person’s nonverbal behavior, hearing what the person’s voice communicates and assessing the congruence between the person’s words and behaviors. Examples of verbal following and minimal encourages are, “Oh, can you tell me more?” and, “Um-hmm,” and “Really?”

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FOCUSING SKILLS

ReframingReframing is helping the person change his/her frame of reference in such a way that the problem can be approached in a positive way. It refers to the process of assisting the family member in identifying a different framework for understanding and responding to a problem. For example, we can view change as painful or frightening, or we can reframe change as manageable stages leading to a new opportunity.

ClarificationClarification is a process you use to help family members develop an understanding and awareness of their feelings, thought and behaviors. Clarifying responses facilitate the development of the family member’s awareness and understanding of himself/herself.

QuestionsEffective communication involves combining different types of questions. Questions should be used carefully and sparsely. Questions are a way for the child welfare worker to focus a conversation.

Open-ended questions are used to encourage communication, gather information and explore issues. Family members can answer as they choose, giving them an opportunity to explore their thoughts, feelings and experiences. Questions starting with the words how or what encourage the person to explore and allow him/her to express his/her own feelings, views and perceptions.

Closed-ended questions are used to gather specific factual information. Closed questions begin with the words who, when, will, is or where and usually can be answered with a one-or two-word answer.

Indirect questions are statements that imply a question. Indirect questions can begin with, “Tell me…” or, “I’ve been wondering…” Indirect questions can be used to explore sensitive subjects and can lessen the harshness of a series of questions.

Solution-focused questions are used to move from reframing to solutions. Solution-focused questions empower families to find their vision of success and their own strategies that have worked or will work for them. Solution-focused question can be used to define the problem, determine when the problem does not exist and encourage the family to specify what they do want.

Summarization helps you to synthesize a wide range of facts and feelings communicated. Effective summarizations contain no new or additional information but bring together information regarding facts or feelings previously discussed. Summarizations can be used for a variety of purposes. Following are some of the purposes:

To keep the interview focused and on track, especially in rambling or disjointed conversations

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To check your understanding of what the person is saying To highlight contradictions or ambivalence (The phrase “I am confused” can

be helpful in seeking greater clarity.) To structure the interview, particularly in the beginning and in the end of the

interview

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Conducting QSR interviews

The first step in preparing to engage in QSR interviews is to participate in an organized training program for reviewers. It is vital that reviewers understand the whole QSR process and not attempt to "just do it". Reaching a level of knowledge and comfort with the QSR protocol and scoring system will permit the reviewer to focus more on the quality of the interviews, and less on their own anxiety.

The following list is not intended to be exhaustive, but rather to remind interviewers about important aspects of the QSR interviews.

Prepare for interview by being oriented to basic facts .Before any interviews start, try to be sure that you are oriented to the basic facts of the case. A brief review of the record, with an emphasis on key documents such as assessments, service plans, and the most recent progress notes will be helpful. When possible, having copies of key documents will be helpful both with interviews and, later, with writing your case story. The initial interview with the worker will also help you to fix import basic information about the case in your mind, so that is less likely that you will be confused about basic information such as names, relationships, and the roles of different people in the case.

Explain the QSR process .Every interview should begin with a polite introduction and a brief explanation of the purpose of the interview and the importance of the person you are interviewing to understanding how the case is progressing. The introduction provides an opportunity to clarify that the QSR is intended to improve services to children and families, that it is not an audit or an investigation, and that (with the exception of mandatory reporting) the person interviewed may ask that information shared be held in confidence. The detail and formality of the introduction will depend on whom you are talking to.

Consider how to best engage children/families .Often, it's possible to get assistance with some starting ideas about how to engage individuals you will interview. For example, your initial interview with the worker could provide you with the opportunity to ask about how to engage a particular parent or child. The worker might tell you that the child really hates school, so you might want to start with some opening line other than, "How are you doing in school?"

Be attentive to clues about family culture .As with good case practice, engagement is an important starting point. Look for opportunities to put the person that you talking to at ease. Be respectful and attentive to cues about family culture. Sometimes, cues in the environment will provide an informal starting place -- is the home filled with family pictures?, is the child's room decorated in a Sponge Bob Square pants motif?, does the family have a tropical fish aquarium?, is there special collection of eagles?

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Know what you need to learn from person interviewed. Remember that there is no script for the interviews. Every interview will be individualized to the particular needs and requirements of the case, and of the person to be interviewed.

Allow each person to tell their story A key principal is to allow the person being interviewed to tell their own story in their own way. In most cases, the broadest possible opening questions allow the greatest freedom to assess the priorities and interests of the person you are talking to rather than immediately "telegraphing" your own interests and priorities. Broad, open-ended questions permit the person you are talking to "to tell their story". For example, "Can you help me understand how your family became involved with the child welfare agency? is less directive than, "Tell me about how your daughter was abused." Similarly, asking a therapist, "What do you think is the most important thing to understand about this case?" permits the therapist to go in a lot more directions than, "What do you think about this child's diagnosis?"

As the interview progresses, you will often learn much of what you need to know through engaging in a conversation; without asking many direct questions. Often, reflection, summarization, and specific attending skills will be sufficient to move a conversation along and to gain a great deal of information. Solution focused questions often elicit ideas that help you to understand how the other person sees the issues in the case. For example, "What would need to happen for you to feel safe at school?" is likely to be more evocative and informative than, "Do you need anger management classes?

Toward the end of the interview, it may be necessary to ask more direct questions to fill in important information. By this point, however, you have had the opportunity to assess what the person you are interviewing thinks is important -- the things that are foremost in their mind.

It is always helpful to preserve a few minutes at the end of the interview to ask specifically if there is anything that has been missed or overlooked that might be important to understand.

If there is information that might be expected to be emotional or anxiety producing, the end of the interview is a better place to address these issues than the beginning. There has been time to build trust and respect; and if broaching the issue causes the person to "clam up", you will have accomplished most of your interview.

You want to understand the perspective of everyone you interview on every important issue.

The QSR is not a "fill in the blank" exercise. For example, the worker may tell you that the parent really likes the services they are receiving and finds them helpful. That information does not relieve you of the responsibility of asking the parent about their services. The worker and the parent might have very different views on this issue. Similarly, because one person interviewed says that the child is not receiving special

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education services doesn't mean that you might not want to ask the same question to several other people you are interviewing.

Reviewers do not share information from one interview to the next . For example, reviewers may learn in a prior interview that the permanency goal had changed from reunification to adoption. The reviewers would pay attention to the fact that this piece of news was unknown to the Guardian ad Litem, but would not share the information during the interview with the GAL (although they would probably discuss the need to update the GAL with the case manager during the exit interview).

Ask each person interviewed about child safety. Generally, it is good practice to ask everyone interviewed if they have any safety concerns about the case, even if no safety concerns have emerged during the rest of the interview.

Collaborate with your reviewing partner. Use the time between interviews to consult with your review partner and to look over the list of indicators to see if you are gathering all of the information you will need to score each of the indicators.

Use your review partner to share responsibilities like finding that you have only an hour to interview the parent and the child. You may also find that your review partner knows a great deal more about a particular subject area. It is important to have established cues about how to "switch drivers" so that you and your review partner did not disrupt one another’s train of thought.

Prepare for special challenges. Try to be prepared for any special challenges that might develop during your interviews. For example, if you know you're going to be interviewing younger children, having useful "props" like paper and markers, small toys, etc. can make the interview a lot more productive. Similarly, if you know you will be interviewing an angry adolescent who feels ignored and disrespected; it would be helpful to think about how to highlight the importance of their opinions and perspective.

Stay within the role of a reviewer. The QSR interviews are a different experience for many reviewers accustomed to other types of interviewing. It is important to remember that the QSR interviews are intended to gather information needed to understand all of the child and family status indicators, and all of the system performance indicators. It is not an investigative interview, supervision, or an opportunity to demonstrate the reviewer’s own expertise in case management, agency policies, or how things occur in other child welfare systems. It is not the reviewer's role or responsibility to "fix the case". That is the work of the case manager and supervisor.

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Remember the obligation to report child safety issues. Finally, it is important to remember that reviewers have mandatory reporting responsibility if there are child safety issues that come to light during a review. Generally, the review leader will provide guidance about reporting imminent safety concerns, but it is the reviewer's responsibility to bring safety concerns to the attention of appropriate agency personnel.

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Sample Questions for QSR Interviews

Listed below are some exploratory questions that can be quite useful in the review process. A number of variations are provided so the question selected can be relevant for the person being interviewed. The thoughtful use of exploratory and solution focused questions allows you to learn a lot of information without asking too many questions, implying what the answer is, or conveying judgment.

For the most part, each question you ask should be dependent upon what the person has answered in regard to your last question. This demonstrates that you are listening and will lead to a depth of information that will much enhance your review findings. This list is not exhaustive.

Interviews with Families

Note: It is always good to let families know that you have had a chance to read the case record. If they do not bring up a difficult topic, such as participating in a drug treatment program, you can ask later in the interview, “I noticed in the record a mention of your participation in a drug treatment program. Can you help me understand more about that?” or, “I noticed in reading the record that you had once been diagnosed with a Bi-Polar Disorder. Did you think that was an appropriate diagnosis for you?)

Explain process to families with children present as age appropriate. Let parents know in every family that children and parents often have different perspectives, and sometimes it is helpful to interview each person separately. Let family decide, and determine order of interviews.

To get the discussion with parents started:

“How did (your child) become known to the agency?”

“How did your family come to be involved with the child welfare system?” “When things are working well in your family, can you tell me what it looks like?”

“Can you help me understand who are the people in your immediate family?” “

“Who do you call (or talk to) when you feel good (or bad)?”

“Who are the people who care about you, and about your children?” “Who do you call if you need something?” If a person says that they cannot think of anyone who cares about them or their family you might try: “If your car broke down on the interstate, who would you call to help you?” Or “Who do you spend holidays with?” “Who would you invite to your child’s birthday party?”

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Follow-up questions:

“What is your biggest worry for your children?”

Some families have a clear view of their immediate and long range goals and will be able to articulate them. The use of the miracle question is helpful when a family member appears to be having difficulty envisioning what they would like to be different in their lives. It is important to establish some rapport with the person being interviewed before a miracle is asked.

“Suppose tonight, while you are sleeping, there is a miracle and the problem that brought you to child protective services is solved. Since you are sleeping you don’t know the miracle has happened or that the problem is solved. What do you suppose you will notice that is different the next morning and tells you the problem is solved? Follow up with: If the miracle happened, what would be the first thing you would notice? If the miracle happened what will be the first change you will notice about yourself? What would your spouse notice is different about you? What would you notice is different around your house?”

“If you could have 3 wishes, what would they be?” Be careful with children that you explain that you do not have the power to grant wishes.

“What are (agencies involved) trying to help you with at this point?” (Family’s perspective as to who is on the team and what each team member’s role is.)

“What seems to be helpful to you?” “What is not helpful?”

“To what extent were you able to participate in the development of your case (service) plan?”

“You mentioned that you had some concerns with…. Can you please tell me about them?”

“And how did that affect you/the child/your family?”

“Help me understand about how the final decision for TPR was reached.” (You can plug in any decision, of course.)

What is your thinking about what your child needs to feel safe at home?

“What is your thinking about why the children do not want to return home?”

”Help me understand what the therapist is working on” might reveal if underlying needs are being addressed. It will give a general picture of how much is really known about the child/family and the degree of communication among all team members.

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“To what extent does the child’s therapist involve you in the development of the treatment plan? “To what extent are you kept informed of progress?”

“On a scale of 1-10, with 10 meaning you have every confidence that this problem can be solved and 1 means no confidence at all, where would you put you put yourself today?” A follow-up question might be, “What would it take to bring your confidence up one level?” Scaling questions are an excellent way to help a family clarify their thinking about progress (or lack of progress) on key issues.

“Have you ever had the opportunity to attend a child and family team meeting?” If so, “Do you remember what was discussed there?” “Who attended?” “To what extent were you asked for input?” “In your opinion, whose meeting was that?”

Closed-Ended Questions

There will also be some times during an interview when the use of closed-ended questions is an appropriate follow-up to something an informant has said. Closed-ended questions begin with the words who, when, will, is or where.

“Are there people that you would like to spend more time with? If so, who are they? This is an important question for children in out-of-home care.

Solution-Focused Questions

“What have you tried that has worked/not worked?”

“How come things aren’t worse?” This is good to use when family member cannot identify exceptions or dream of a future without the problem.

“It’s not easy to raise three children on your own. How did/do you do it?”

“If things could be better tomorrow, what would tomorrow look like?”

“What is the one thing that would be the most helpful to you?”

“With all the transition and change taking place in your life right now, what is the one thing that will sustain you?”

“Can you tell me about the good things that have happened over the past year?” (This is also good question for older children.)

Tell me how you are involved in the lives of your children?” This question could be asked of a non-custodial father.

“As you think back over the difficult times in your life, who or what helped you through them?”

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“You have told me that this child has some anger issues. Can you think of a time when he was not angry? What do you believe happened to cause the anger?” Many times a family member can identify the point in time when things got bad….like his anger started when his father promised to visit and didn’t and he never contacted his child again.

“If we could go back to the time when your family (or this family) first became involved with the system, what do you think could have been done differently that would have been better?”

Questions for Children

Note: For younger children, ways to elicit conversation include asking them to draw pictures of family members; draw a happy day and a sad day; draw simple faces and ask child which ones match the way they feel with Mom, Dad, at school or day care, with current caregiver. Ask what would make them have a happy face with regard to each person.

(Older children like to know their opinions are the most important ones in the case!)

What do you like to do for fun? What are some things you used to do for fun?

What music/movies do you like? If you could do anything, what would it be?

Do you have a girlfriend/boyfriend? What do you like about her/him?

What do you want to be when you grow up?

Tell me three words that would best describe you. In addition to the three words that describe you, what other words would you like to have describe you? (For younger children, ask what animal do they think they are like, with a follow up question to learn how they feel they are similar.)

What do people like about you the most? What is something about you that others would like to change?

Describe a typical day for yourself. If you could plan a great weekend doing anything you want, what would you pick to do?

Where do you and your friends go to hang out? Are there people that you used to spend time with that you would like to spend more time with? If so, who are they?

Who do you admire most and why? What would help you to follow in the footsteps of this person?

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What are the qualities of a good friend? What could improve the time you spend with family and friends?

How does your family have fun?

Every family has things they worry about? What are the worries in your family?

If you could change one thing what would it be? What would you want to be different? (A miracle question for a child is the three wishes question, being careful to explain that you can’t make them come true.)

Let children know you always ask any child you interview about how they feel about their safety. Ask, “Is there anything right now that anyone might do to make you feel safer?” Scaling questions with children who know numbers can be effective in asking where there are right now and what would move the number up by one? Young children can be offered a visual aid, such as this side of the room is when you feel totally safe, and that side is when you feel very scared…when you are with (Mom, Dad, Caregiver) where are you in this room?

Depending on child’s age, you can ask if they were the teacher giving grades, what grade would they give the people who are helping their family. No matter what the grade, ask what could that person do to get an even higher mark (such as an “A+).

Other Persons (Case Managers, Providers, GAL, Teacher, Attorneys)

“What is your role in this case?”

“How long have you been involved?”

“What do you think is the most important thing to know about how (the focus child) is doing right now?”

What do think is contributing to that?

“I have read in the record that this child has some behavior issues. Can you describe for me what his behaviors are in your classroom?” “I understand he has good days and bad days. Can you think of what might be going on during the bad days?”

“Who else cares about this child/family?” (A good question to ask the case manager, foster parent and providers and then compare their answers to that from the family members.)

“Who would you put on this family’s team?” This might reveal the degree of knowledge about the formal and informal support system.

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“What do you think is the most important thing to understand about this case?” (This is a great question when the informant does not have a lot of time scheduled for the interview.)

“Who are the other persons involved on the team in this case?”

“What are their respective roles?”

“What do you believe are Mrs. ___’s underlying needs?” (Help the person to keep this separate from the services.)

“What is your understanding of the goal for this child?”

“What do think is the likelihood of this goal being achieved?”

“What else do you think could be done to help this child (or family) achieve this goal?”

“What are your worries for this child, or family?”

“What will it take for this child (or family) to live without (child welfare agency) involvement?” This will get lots of information about the long-term view and sustainability of any progress made.

“What will help the child transition back home; to foster care; etc?”

Interview Closing Question

If the case manager or any provider tells you that she/he is ready to close the case you might ask…”If you close this case, do you think you will see this family back in the system?”

“Is there anything else that you think it’s important for me to know?”

“DO YOU HAVE ANY CONCERNS FOR THIS CHILD’S SAFETY?”

“On a scale of 1-10, how safe do you think this child is?” One being very unsafe and 10 being the most safe she could be. If the answer is say, a 7, then you might ask what could happen to make that an 8.

“If you had to put a plan together right now, what would be needed to safely close this case?”

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Guide to Case Feedback to Workers

One of the features of the Qualitative Review Process that sites find most useful is feedback to individual caseworkers about their cases at the conclusion of the review. The worker “debriefing” is intended first to assure that the reviewer’s perception of the case is accurate factually and second, to offer any suggestions that might be considered to improve case outcomes. In providing this feedback, the following process is suggested as an approach to constructive information sharing and coaching.

Beginning the Conversation

Remember that the process of having anyone review your work is anxiety producing, even more so when the reviewer is a stranger and characterized as an expert. Please keep this in mind when you meet with the worker about observations.

Point out to the worker that the purpose of the debriefing is to make sure that you have understood the current status and facts of the case accurately and also to offer any suggestions that might be helpful. Of course, you should start with the strengths of the case. Include strengths of the worker’s contribution as well as those of the system. Be specific and explain why you think the positives found are important. A little self-disclosure can be reassuring, so in cases that are not going well, consider sharing an example of your own struggles with difficult cases.

Describe the current status, key players and important issues observed. It is not uncommon to learn things about the case that the worker does not yet know, because you have had the opportunity to view the case more recently and talk to all of the contributors at one time. When this occurs, it helps to remind workers that it is not unusual to learn new facts during reviews because we have the luxury of being able to invest substantial time in each case.

At this stage, it is also common that you find that the case plan has not been kept current with events or intentions in the case. A gentle way to approach this is to offer the worker an opportunity to tell you what he/she expects to do in the next month related to the case, even if intentions have not yet been incorporated into the plan. Some reviewers say, “What would you have liked to have done differently, knowing what you know now?” or “Having heard these facts, what would your plan for this child/family be, or what ideas do you have for addressing the current issues.” This option provides a solution-focused opportunity for the workers to address their own case issues.

Discussing Practice Challenges

The most sensitive part of the debriefing process is offering feedback about the practice challenges that were observed. It sometimes helps to let the facts of the case communicate issues of concern, rather than stating them as your own assessment. For example, rather than simply stating “the school is unaware of the child’s psychotropic medications and doesn’t understand their effects on the child” (implying that the worker

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should have provided them), you might say, “the teacher wondered if the child was on medication and how that was affecting his behavior. What is the system’s policy on sharing such information?” Quotes from case stakeholders can be a less judgmental way of surfacing issues. Be certain, however, that you don’t reveal a remark that the family member or stakeholder didn’t intend for you to share.

When contradictions to the worker’s perspective or understanding of the case are exposed in the case review, the time-tested phrase, “I’m confused…” is another nonjudgmental way of communicating the identification of discrepancies. For example, regarding differences in the understanding of case goals, you might say, “I know that reunification is the permanency goal, but I’m confused because several of the case contributors seem to think that this child will never go home. Am I misunderstanding this?”

Discussing Recommendations

It is wise to be clear that having only spent a day and a half reviewing a case, it is not always possible to surface practice development ideas in such a short span of time. If you have suggestions, however, it is helpful to describe them as options for the worker to consider. We do not want to dictate case practice in this role, so be sure the worker understands that you are only identifying options that might be useful.

If there are serious case problems, particularly related to safety concerns, using the term “concerns” is a good characterization. For example, “One concern that I want to share is the fact that the mom’s therapist worries that she has begun using drugs again. I don’t get the impression that this has been communicated to you, but is seems important to me,” is a way of communicating the concern without criticizing the worker for not yet knowing a key fact. In the uncommon event that you discover an imminent risk of harm to a child, remember the obligation to insure that it is communicated to the worker and supervisor.

The hardest form of feedback involves communicating concerns about an issue that the worker doesn’t see as harmful. A common example is the lack of concern (or at least resignation) about children with frequent moves. This is as much a system issue as an individual practice issue. You might say, “I know you’re as concerned about the number of placements this child has had this year as I am. What resources can the system offer to stabilize this child? If you had the power to change the way the system functions, what would you do?” Again this solution focused question permits the worker to contribute to the case solution.

Don’t overwhelm the worker with suggestions. Also, separate system solutions from changes in worker practice. Workers are most interested in what they could do differently tomorrow.

In concluding the debriefing, you want to be sure that in your efforts to be strength based you haven’t led the worker to believe that status and performance issues are better than you actually found them. When/if the reviewer knows at the time of the debriefing that one or both domains will likely be rated “unacceptable”, it should be communicated

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clearly, in the context of any mitigating aspects such as systemic difficulties beyond the control of the worker or newly surfaced information. “Although a lot of good work has been done in this case, the fact that the man that was suspected of fondling Marie is back in the home creates an unacceptable safety rating. I want you to be aware that an unacceptable safety rating will result in an unacceptable child and family status rating.” The written case story shouldn’t be a surprise.

Of course balancing candor and affirmation are the challenges that make this process so useful. Before you conclude, give the worker an opportunity to ask questions. It is always helpful to conclude by providing a wrap up and review, to check out what the worker has heard (or perceived) in the debriefing. It may be really helpful to ask for feedback directly, such as, “Having heard all this, have we gotten things ‘right’? Are there pieces we may have missed or misunderstood?” It doesn’t hurt to end with a highlight that reflects some strength or progress directly related to the worker’s efforts or skills.

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Qualitative Case ReviewQualitative Case Review“Jorge”

Date of Qualitative Case Review:

Reviewers:

FACTS ABOUT THE CHILD AND FAMILYFACTS ABOUT THE CHILD AND FAMILY

Family Composition: Jorge is a twelve year old Hispanic male who lives with therapeutic foster parents, their two teen-age sons, and a younger foster male foster child placed in the home one month ago. Jorge’s seventeen year old half-sister, Claudia is in a different placement in the Independent Living program. His two younger brothers live in a different foster home in the same neighborhood. English is Jorge’s second language. Jorge communicates by phone and letters with his mother who is incarcerated in a federal prison out of state. He also has two maternal aunts and many cousins in the Salt Lake area.

Prior CPS Investigations and Child Welfare Involvement: There was a CPS report in 1998 alleging Domestic Violence related child abuse of all four siblings with his mother and her boyfriend as the persons responsible. The investigation concluded without the family being located. The second report followed within two months with the same allegation and persons responsible and was substantiated. A report alleging physical abuse of Jorge by one of his aunts was not substantiated two years ago.

Permanency goal: Primary = Guardianship (Foster Parent)Concurrent (if applicable) = Individualized Permanency

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The reviewers interviewed 8 persons: Caseworker and Caseworker’s Supervisor, Jorge, Therapeutic Foster Parent, Special Education Teacher, Therapist, State Attorney, Agency Nurse

CORE STORY FOR THE CHILD AND FAMILYJorge’s mother and sister Claudia were born in Mexico. The legal status of his father is not known. Jorge and his two younger brothers were born in Utah. When Jorge was six years old, his father and mother separated.

His mother got involved in a relationship with a man who was very abusive. Jorge and his siblings witnessed significant acts of violence against their mother. At times, the children would go to stay with their two maternal aunts.

Jorge began first grade in Salt Lake City and qualified for an IEP at the time due to disruptive behaviors. The aunts took all four children back to Mexico where they lived with a paternal uncle and his wife. Jorge went to first and second grade in Mexico. It is not known if his mother went with the family at that time. Jorge did not like living with his paternal uncle. He says that the uncle beat him with a belt. He also says that he missed a lot of school there, and that the rules for attending school were not strict.

Jorge, his siblings and his aunts returned to Salt Lake when Jorge was in the third grade. He lived with his mother and her boyfriend, and the domestic violence continued. Again, at times the children stayed with their aunts to avoid witnessing the ongoing violence at home. Claudia assumed many care giving responsibilities for her brothers as they were growing up.

When Jorge was ten years old, his mother’s boyfriend was arrested and convicted of drug possession. A few months later, his mother was arrested for drug trafficking. She was convicted and sent to a federal prison in California. At the time, she gave custody of her four children to the maternal aunts.

In the year after his mother went to prison, Jorge started a fire outside the home near a pile of trash that spread to a car and a camp trailer, then the home. It completely destroyed the aunt’s home. There was a significant amount of smoke damage and the home was later repaired. As Jorge had demonstrated persistent serious behaviors in school, he was placed in a therapeutic foster home. His siblings were placed in different homes.

After about eight months in therapeutic foster care, Jorge was returned to his maternal aunt’s care. His siblings were also returned home. After two months back with the aunt, Claudia reported that her other uncle had been sexually abusing her. The siblings were removed, and during the CPS investigation it was learned that Jorge had also been physically abused while in the home. There was also concern that the siblings had not been in the care of the aunt that they were placed with.

Jorge asked to return to the prior therapeutic foster care home, where he has now remained for eleven months. A maternal uncle in Mexico has asked that the four children be returned to his care. Jorge and Claudia do not want to go to; however the younger brothers have expressed a desire to go. Placement work with the Interstate Compact Unit is underway for the younger brothers. An approved Home Study on the uncle’s

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family has been received. The four siblings recently had a good-bye visit as it was thought that the boys would be leaving imminently. It was subsequently learned that the boys needed to establish citizenship in Mexico before they could begin school there. The legal steps to establish citizenship for the boys is now underway.

Factors Contributing to Favorable ResultsJorge has a sense of stability in his current foster home and is excited to be able to remain there, although his mother and sister pressured him to agree to go to Mexico. His foster mother says that he can stay until “he is ninety years old.” He is somewhat reconciled to his brothers going back to Mexico. He and Claudia have decided that they have each other and that the younger brothers will likewise have each other in Mexico.

Jorge has started in a new middle school this year and he reports that his grades are the best they ever have been. He is receiving all A’s and B’s. He is in a resource class for two subjects, reading and math, and his Special Education Coordinator co-teaches his English class. The school reports that there have not been any behavior incidents this year. Jorge is well-liked by students and teachers. He is doing so well that the Special Education Coordinator believes that his Special Education classification will be changed from “Emotional Disturbance” to “Learning Disability” when he is re-tested this February.

Jorge’s foster mother fought hard to have him assigned to his current middle school rather than attend the self-contained program for foster youth that his prior school had recommended. She felt that he would do better without the stigma

associated with the self-contained program, and would benefit from new opportunities to attend some mainstreamed classes.

The caseworker and the therapist attended school team meetings with the foster parent in the spring and summer to assist with school placement planning and the transition to the new school.

Jorge likes both his case worker and his therapist. He says the therapist makes him angry at times, but that it helps him to attend therapy.

The caseworker speaks Spanish and has invested much time in conversations with Jorge’s mother and family in Mexico, all of whom do not speak English. The caseworker listened to the family’s strong desires to have the children returned to the maternal uncle in Mexico and exercised due diligence in attempting to arrange for this placement.

The therapist for Jorge responded to Jorge’s desire not to go to Mexico, and advocated to the judge on Jorge’s behalf to allow him to remain with his current foster family.

Factors Contributing to Unfavorable Results

Team members have different understandings as to Jorge’s desires for adoption. Jorge says that he would like to be adopted by his foster family, and that he has wanted this since he was first placed with the foster family. He says that his foster parents are not ready, so he is taking “one step at a time.” When Jorge thought he would have to go to Mexico, his behavior in school started to deteriorate. His Special Education teacher called his foster parent to find out if and when he would be leaving. The teacher

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was told by the foster parent that he would not be going, and the teacher then assured Jorge that he would not be leaving. Jorge’s behavior in school immediately improved.

The team left the final decision to the judge. At the most recent hearing, the court granted guardianship to the foster parent, and custody to DCFS. Jorge knows this arrangement is slightly different from the current foster care arrangement and feels it is a step in the right direction. He is quite aware of the different status of the children living in the home: the biological brothers who “belong” to the foster parents; the new foster child; and third, Jorge (due to his guardianship status).

Some team members believe that Jorge does not want to be adopted and that he might want to choose to be reunited with his mother when she is released from prison in (2008) two years. Jorge has told his foster mother and his therapist that he has no desire to be reunited with his mother. His mother is not a U.S. citizen, and will be deported to Mexico when she is released.

The foster parent told the reviewers that she was a bit anxious about what Jorge will be like as a teenager “because she has no experience with raising teens”. She also was reluctant to lose the many collateral services that are currently available for Jorge if she were to take permanent custody.

Jorge feels that his brothers have chosen to go to Mexico as they are afraid that they will be adopted if they do not go. It is possible that Jorge is reluctant to voice his desire to be adopted to his team as his foster parent is not yet ready, and

perhaps he feels he might be moved from this home.

The team left the final decision as to placement of the siblings with the judge who decided that the brothers would go and Jorge would stay in a long term foster arraignment. At this point, the decision of reunification with his mother has been left to Jorge.

Jorge’s closest family member appears to be his sister Claudia. She has also struggled with the separation of the boys, and wanted all three to go to Mexico. She believed that this was the best way for them to be reunited with their mother in two years. Team members have viewed her behavior throughout this process as manipulative. She has not been engaged by team members and supported to participate in team meetings in an effort to reach consensus as to the best resolution for the family. She also has a therapist; there has not been communication or coordination between her therapist and Jorge’s therapist.

There are some ongoing tensions between Claudia and Jorge’s foster parent around the expectations for visits. Claudia recently brought Jorge back several hours after the agreed upon time, and also has her boyfriend present during some of the visits.

A plan for on-going communication with the brothers once they go to Mexico is yet to be developed.

There was significant background information that Jorge’s therapist had documented in an earlier assessment that was not known to the caseworker or incorporated into the written child and family assessment. There were also some health concerns that team members were

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not aware of (mild obesity, a steel pin in Jorge’s ankle, and past treatment for TB that mitigates against future TB testing).

Six Month PrognosisJorge is doing quite well emotionally and academically at this point. Given the ongoing supports he receives from his team, he is expected to continue to do well.

Practical Steps to Sustain Success and Overcome Obstacles

The team members need to achieve an understanding of Jorge’s desire for permanence with his current foster mother, and also whether it is appropriate to leave the door open in terms of reunification with his mother. Possible ways to strengthen Claudia’s engagement and participation on the team might be beneficial to Jorge and the sibling group as a whole. Claudia’s therapist expressed an intention to strengthen teaming with Jorge’s therapist which would also be a way to assist the siblings with resolving some of their differences about the future when their mother gets out of prison.

The caseworker is planning to assist the foster mother and Claudia with development of a working agreement to clarify expectations for visits with Jorge.

Jorge’s situation reveals important systemic barriers which create financial and service consequences should his therapeutic foster provider chose to adopt him. Ways to mitigate these barriers need to be identified by persons responsible for funding and policy.

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