Introduction

WelcomeIntroductions

Handouts: • PowerPoint• Training poster

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Agenda

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The MnCFSR measures safety, permanency, and well-being outcomes for children and families in the child welfare system. Modeled closely after the federal Child and Family Service Review, the MnCFSR:

• Evaluates social work practice and promotes practices that encourage family engagement in achieving outcomes

• Examines the impact of key systems on agency efforts to achieve outcomes (for example; the court system, staff and supervisor resources, service array, etc.)

• Is designed to provide feedback to social service agencies about both strengths and areas needing improvement

The MnCFSR is built on a model of accountability for making improvements when needs are identified; partnerships between the Minnesota Department of Human Services and county agencies support ongoing quality improvement activities.

This poster is a graphic of the seven outcomes and performance items used to measure outcome achievement.

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This slide depicts Winona County Human Services’ experience with the MnCFSR.

The quote on the right side of the slide is drawn from the “Values and Principles” section of the Minnesota Child Welfare Practice Model, and highlights both high performance standards and efforts to achieve outcomes through ongoing quality improvements. Like similar-sized agencies, Winona County is on a three- to four-year cycle for quality assurance reviews. The cyclical nature of the MnCFSRs supports ongoing quality improvements in child welfare casework.

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This week, eight cases were reviewed, which is a small number when compared with agency totals. However, what was learned from federal partners and feedback from Minnesota county and tribal agencies that an intensive examination of a small number of cases often identifies themes or patterns present across broader casework.

Cases for the review were selected at random, with adjustments made to ensure equal distribution between workers and units, and to match the racial/ethnic ratio of Winona County’s placement population to the greatest extent possible.

The case sample included:

• Three in-home cases where child protective services were being provided and the child(ren) remained in the home. No child in a family was placed outside of a home for more than 24 hours during the period under review. Cases were selected only if 45 days or more of post-assessment services were provided during the period under review.

• Five placement cases where a child was in placement for 24 hours or more during the period under review, and received services. Where there was more than one child in placement, one child was identified as the subject of the review. Cases were selected from any of the following program areas: • Child protective services

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• Adoption• Children’s mental health

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Findings from the MnCFSR, and the resulting PIP recommendations, are drawn from two sources:

• Results of the eight cases under review• Agency performance on key child welfare data indicators, representing the

experiences of children across all cases.

Information from stakeholder interviews and surveys, as well as the structured interview completed prior to the review week, provide additional information that supports understanding of the findings within the context of the local child welfare system.

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Reviewers examined case records and conducted case-related interviews with children, parents, foster parents, and others directly involved and impacted by the agency’s work. The left column depicts the number of case-related interviews conducted.

In addition to case-related interviews, two interviews were conducted with key stakeholder groups. These interviews were not case-specific, but instead focused on how the broader child welfare system works to support safety, permanency and well-being for children. The right side of the slide identifies stakeholders interviewed as part of this MnCFSR.

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Overall, the agency demonstrated sustained or improved performance on five of seven outcomes when compared to findings from the 2011 MnCFSR. Factors that contributed to higher performance across performance areas included:

• Timeliness of initiating investigations and assessments• Children safely maintained in their homes whenever possible• Priority of siblings placed together and use of relative placements• Needs assessment and services to children• Children received adequate services to meet their physical and mental health needs

For practice areas identified as strengths, factors that supported strong performance will be discussed. Barrier to stronger performance in areas identified as needing improvement will also be discussed.

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SAFETY OUTCOME 1: Children are, first and foremost, protected from abuse and neglect.

This slide depicts agency performance on Safety Outcome 1, as follows:

• On the left is the one performance item used to measure outcome achievement; Timeliness of response to reports of child maltreatment

• On the right, the bar graph indicates the percentage of cases reviewed that were determined to be substantially achieved on Safety Outcome 1

• The graph includes agency performance over time, starting with the blue bar, representing Winona County’s performance in 2011; then the county’s 2015 case review results are reflected in the green bar. The purple bar at the far right indicates state aggregate performance, which includes all counties and tribes reviewed between 2011 and 2014.

The agency’s performance in this review remained the same when compared to the 2011 review and is lower when compared to the state aggregate. Two of the three applicable cases were rated as a Strength.

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Case Review:

Item 1: Timeliness of response to reports of child maltreatment.

Timely face-to-face contacts are critical to protecting children from additional episodes of abuse/neglect. In the cases reviewed, 67 percent (2/3) of cases were rated as a strength.

Agency practices that supported timely responses included:

• Use of daily screening team decision making. In all of the cases reports were screened in within 24 hours, as required by statute.

• Case assignments were made on a daily basis, with consideration for worker availability to make timely contact.

• Timely face to face contact occurred with the alleged child victim.

Barriers to timely face-to-face contacts in the cases reviewed included:

• Adding new allegations to an already opened investigation, which resulted in a child not being seen within 24 hours. The workgroup was closed without face-to-face contact with a child.

• In one case a case management workgroup was opened without a corresponding

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maltreatment allegation.• Only three of five cases were applicable. Cases were not applicable if there were no

screened-in maltreatment reports during the period under review.

The agency self-assessment indicated that prior to two years ago, staff composition was very stable. However, within the last two years, staff turnover has increased, and the agency is in the process of orienting and training new staff members. This may have impacted consistency in practice. Agency staff is working towards building to full capacity to meet workload demands.

Due to the critical nature of this performance item, the Minnesota Department of Human Services (department) has set a state performance goal that initial face-to-face contacts will be made within statutory time frames, with 100 percent of children identified as alleged victims of maltreatment. The department is aware there are statutorily acceptable reasons for delaying contact with a child; therefore, agencies who do not have a timely face to face contact with at least 90 percent of children are asked to develop strategies for improvement.

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Broad Performance

This slide reflects performance data regarding agency and state rates of timely responses across all maltreatment assessments and investigations closed in calendar year (CY) 2013 and (CY) 2014.

Strong performance exists is in all performance measures. This indicates that the agency has placed a high priority on initiating timeliness of contact and improved performance in substantial child endangerment and Family Assessment since 2013. Strong performance is also indicated in responding to reports of non-substantial child endangerment assigned for Family Assessment.The agency has sustained performance above the statewide aggregate in calendar year 2013, and quarter 4, 2014.

Based on the agency self-assessment and structured interviews, when delays occur it was most often in situations where the alleged perpetrators did not provide care for a child who was in another setting when the report was made, when no current address was available or when there is not a current address or lack of information was not available to immediately locate a family.

A PIP is recommended to improve the rate of timely responses to maltreatment reports based on the case review findings and broader agency performance. The 90

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percent state performance goal in Substantial Child Endangerment has not been met.

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Safety Outcome 2: Children are safely maintained in their homes when possible and appropriate.

There are two performance items used to measure this outcome that measures practices critical to how the agency assesses and addresses safety for children.

Agency performance on Safety Outcome 2, when compared to the previous review in 2011, has remained equal to the 2015 case review, and was higher than the statewide average.

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Item 2: Services to protect child(ren) in home and prevent placement or re-entry in foster care.

Agency efforts to provide services to safely prevent placements and re-entries is examined in this item.

Case Review

In the cases reviewed, 100 percent (2/2) were rated as a Strength. In the case sample, only two of the eight cases were applicable. Six of the cases were not applicable due to being children’s mental health cases; one had a safety plan and in two cases, safety issues were addressed prior to the review.

Practices that support strong performance included:

• Use of natural family support networks – family arrangements and safety planning. Workers explored alternatives to placement whenever possible. Agency staff may consider full disclosure to fully examine use of family arrangements, or is there is a safety issue that needs to be addressed.

• Use of Pre-placement team – workers have access to the Pre-placement team to consult and gain input from other professionals regarding services to prevent entry

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or re-entry into care. Supervisory oversight and consultation were utilized frequently.

• Use of supervision and team consultation in decision making – Pre- placement team.

• Services to address safety concerns and prevent placement were available and accessible in a timely manner; mental and chemical health assessments and services were used in two of the cases reviewed.

• The self-assessment identified frequent use of alternatives to a formal placement option, such as natural family resources, relatives and friends to help support the family with respite, delegations, and custody to the other parent. Also used was Family Group Decision Making(FGDM) to help facilitate problem solving, as well asinformal support networks, whenever possible.

There were no recurring gaps or barriers in the cases reviewed.

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Foster care re-entry examines whether children return to foster care within 12 months of a prior discharge to reunification.

Broad Performance Data

The slide reflects agency and state rates of foster care re-entry. Agency performance is higher than the state aggregate. The national standard is 9.9 percent.

As happens often, all cases in the review were rated as a strength given agency efforts to prevent foster care re-entry. The MnCFSR instrument does not effectively illuminate contributors to the re-entry issue.

Self AssessmentThe agency self-assessment and stakeholders reported limited options for children with mental health concerns and severe behaviors. These children are often placed outside the county. The agency also identified a recent lack of local foster homes skilled and trained in providing behavioral care for high-level needs children. The agency has developed a new wrap around service for teens and young parents with depression and anxiety, which is intended to aide in addressing these issues.

An interview with agency administration indicated that the agency expected re-entry rates to decrease over time due to ending the Title IVE agreement with the County

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Corrections Department.

A PIP based on performance on federal data indicators will be recommended to reduce the rate of re-entry and support permanent reunification for children (Measure C1.4 – Federal Data Indicators).

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Item 3: Risk assessment and safety management

This item examines whether the agency conducts initial and ongoing assessments of risk and safety, and whether identified risk and/or safety concerns are adequately addressed.

Case Reviews

In the cases reviewed, 62.5 percent (5/8) of cases were rated as a Strength. This performance is higher when compared to findings from the previous review in 2011, 38 percent (3/8).

Practices that support strong performance and contribute to comprehensive attention to risk and safety include:

• SDM tools utilized initially and at key decision points in the life of a case. Ratings on this item are not based on whether the tools were completed; however, completing SDM tools is a recommended best practice that supports thorough risk and/or safety assessments.

• Worker visits were frequent and of good quality that included attention to children’s needs in their living environment, development of relationships and interactions with caregivers. A quote from a case related interview included; “the child was not a

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case or number; they care about her and take her safety seriously.”• Safety planning, the case review reflected safety plans being developed and

monitored. When circumstances changed, a plan was updated or revised. Safety plans used informal supports to help ensure child(ren)’s safety.

• Use of FGDM early in the life of a case and throughout, to assess natural supports in a family.

• Services matched the needs of a family and were individualized. Ongoing monitoring and support were evident in meeting case plan goals.

Barriers to risk/safety assessment and management:• In one case worker visits were not consistent through life of case management being

opened. Gaps in worker visits occurred with child for seven months of no contact.• Domestic violence occurred in the presence of the child and was not addressed with

the father. Services were not provided to assess/address the domestic violence issue.

The agency indicated in the self-assessment, which stakeholders supported, that limited local resources were a challenge in accessing services in a timely manner; however, this was not observed in the cases reviewed.

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Permanency Outcome 1: Children have permanency and stability in their living situations.

Three performance items contributed to achievement of this outcome. WinonaCounty’s performance was lower than the agency’s previous review in 2012, as well as the state aggregate.

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This slide details which practice areas were identified as strengths and challenges, based on findings from the cases reviewed, stakeholder comments, or the agency’s self-assessment.

Case Review

Of the cases reviewed, 40 percent (2/5) were rated as substantially achieved. Practices that supported strong ratings in this outcome area included:

• Early relative identification at initial entry into care • Efforts to support foster family contribute to placement stability. Several cases had

one sole placement setting.• Pre-placement team was used to determine placement options and obtain

professional input.• Timely efforts to assist families in completing the licensing paperwork process for

obtaining a foster care license.• Supportive services for foster families to ensure placement stability; transportation,

use of respite care, financial assistance and frequent worker visits.• Timely establishment of permanency goals and clear permanency timelines.

Barriers to timely achievement of permanency in the cases reviewed included:

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• Delays in achievement of permanency goals due to court extensions due to an appeal being filed and a trial held

• Systemic issues around ICPC processes with Minnesota and other states not responding in a timely manner, contributed to permanency timelines not being met.

The agency self-assessment and stakeholders indicated that barriers in the ICPC process contributed to delays in meeting the achievement of permanency timelines. The agency is exploring the option of a dedicated Adoption worker to focus on the tasks of permanency to improve performance in this outcome area.

A PIP will be recommended based on the case review and broad performance to address barriers to achieving timely permanency for children in their living situations (Onsite Review Instrument (OSRI), Item 6, and federal data indicators measures C2.1, C2.4, and C2.5).

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Broad Performance Data

Timeliness of reunification: Winona County’s performance in returning children to their caregivers within 12 months of placement meets the National Standard.

The C1.4 measure regarding re-entry was discussed in an earlier slide.

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This permanency composite looks specifically at the experience of children and/or youth, and timeliness of the adoption process. The agency did not meet national standard in four of five measures in this composite.

Broad Performance

Winona County did not meet the national standard for adoption of children in care for less than 24 months, the median length of stay to adoption of children, in foster care for 17 months or more and for children free for adoption in less than 12 months. The agency did meet national standards and is above the state aggregate in C2.3, for children in foster care over 17 months and adopted by the end of the year.

A PIP will be recommended based on broader performance of timeliness of adoption for all children.

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Permanency Composite 3 focuses specifically on achievement of permanency for children/youth in care for extended periods.

Broad Performance

Winona County met one of two applicable federal measures.

The agency self-assessment and stakeholders indicated use of Permanent Custody to the Agency (PCA) permanency goal is selected infrequently, and only after all other permanency goals have been fully explored prior to choosing PCA.

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Broad Performance

Winona County’s performance in placement stability is higher than the state aggregateand meets the national standard. The national standard has been met for children in care up to 24 months, as well as for children in care for more than 24 months.

Looking at trend data over the past five years, Winona County’s performance has exceeded the national standard for indicator C4.1 consistently since 2010, and for indicator C4.2 for the past three years. For Indicator C4.3, this measure has fluctuated from a low of 0 percent to a high of 80 percent over the past five years.

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Permanency Outcome 2: The continuity of family relationships and connections is preserved for children.

Five performance items are used to measure outcome achievement. Agency performance in the case review was higher than in 2012, and as compared to the state aggregate.

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Of the five performance items used to measure Permanency Outcome 2, this slide details which practice areas were identified as practice strengths and those identified as challenges.

On the cases reviewed, 80 percent (4/5) were rated as a substantially achieved. Practices that supported preserving children’s connections to their families and significant others in their lives included:

• Placement of siblings together. In 100 percent (4/4), of cases reviewed siblings were placed together in foster care. Efforts were made to match children to placements that would be able to care for sibling units.

• Early identification of relatives and placement with them. In most cases, children were placed with a relative caregivers who were able to meet their needs. Relatives were sought out early in the life of a case, and thoroughly assessed to determine if they could meet the child(ren)’s needs.

• Concerted efforts made to ensure children had quality visits with mothers at a frequency that met their needs and supported their permanency goal, as follows:• Clear visitation plans were developed with families; the agency was engaged in

supporting these visits.• Agency used workers, resource staff, family members and centers to provide

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supervision for visits, when necessary.• Agency used a gradual “step down” from supervised to unsupervised visits and

increased frequency and duration of visits.

• Agency engaged parents in day-to-day parenting tasks and activities.

• Agency appropriately encouraged and/or facilitated ongoing contact with biological parents where appropriate, with agency oversight to support child(ren)’s important connections. Child(ren) were able to continue contacts with cousin and grandparents.

Barriers or challenges to preserving relationships for children with families and significant others included:

• Frequency of visits with fathers, additional agency efforts were needed to facilitate visitation and ensure that visits occurred more consistently with fathers.

• Connections maintained, additional efforts were needed to maintain child(ren)’s important connections in the community, school, siblings not in care and extended relatives.

• ICWA inquiry, there were insufficient efforts in initial and ongoing ICWA inquiry. A negative rating did not occur, but additional ongoing agency efforts are required to determine if ICWA eligibility applies. The agency asked at initial intake, but did not address on an ongoing basis to determine if ICWA applied.

A PIP will be recommended to improve practices to ensure consistent visits with fathers and maintain important connections (OSRI item numbers 8, 9, 10).

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Broad Performance

Trend data available on the Child Welfare Data Dashboard indicates Winona County places children with relatives at a rate that is higher than the state goal. Relative placement trend data has shown a steady increase since 2011. A state goal is 45 percent of children who are in foster care are in relative foster family homes or pre-adoptive homes.

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Well-being Outcome 1: Families have enhanced capacity to provide for their children’s needs.

Well-being Outcome 1 has four performance items that evaluate core social work practices including:• assessing needs of parents, children and foster parents• providing services to parents, children and foster parents• engagement of families in case planning• caseworker visits with children and parents

Agency performance in this review was equal to the review in 2011, and higher than the state aggregate.

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This slide depicts key strengths and challenges across the following four performance items:

• Item 12 – Assessing needs and providing services,• Item 13 – Case planning• Item 14 – Worker visits with child(ren)• Item 15 – Worker visits with parents

In the cases reviewed, 63 percent (5/8) of the cases were rated as Substantially Achieved.

Practices that supported strong performance included:

• Quality of worker visits with children were of high quality. They occurred at residences; e.g. residential treatment settings, relative providers’ homes and at doctor appointments. Visits included alone time with children focused on progress of goals in their case plans.

• Comprehensive assessment of needs for children, mothers and fathers.• Use of Family Group Decision Making to engage families in services early on and

ongoing.• Parents’ needs were adequately assessed; however, additional efforts are needed to

assist parents in accessing needed services.

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• Both parents were identified in every case, and there were no known disparities identified in services provided to both mothers and fathers.

Agency challenges included:

• Gaps in frequency of worker visits with parents and children in both in-home and placement cases (3/5) limited the agency’s ability to comprehensively assess and address case planning needs, and monitor goal achievement.

• Frequency of caseworker visits with parents and children occurred less than monthly in two cases, due to agency not having consistent face to face contacts while case was opened

• Tasks parents needed to accomplish were clearly established; however, there was limited assistance from the agency to reduce barriers and assist parent in accomplishing those tasks.

Stakeholders indicated that due to conflicting priorities, it was a challenge to assess the needs of children and/or parents, and to thoroughly engage them in case planning.

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Caseworker visits with children are critical to monitoring risk, safety and changing needs. The previous rounds of the federal Child and Family Service Review (CFSR) drew clear associations between strong performance on this item and strong performance across all outcome areas. There is a federal requirement and a state statute requiring monthly face-to-face visits with children in foster care.

Broad Performance

Data is drawn from the Child Welfare Data Dashboard and is updated on a quarterly basis. Each quarter represents a rolling year of data specific to caseworker visits with children who are in placement. This slide depicts the previous two full calendar years.

Because caseworker visits with children are essential to ensuring safety, permanency and well-being, there is a federal requirement and department performance goal that 95 percent of possible caseworker visits with children in foster care are made. hismatches the federal goal. This performance goal recently rose from 90 percent effective in federal fiscal year 2015 (October 1, 2014 forward).

A PIP will be recommended to improve consistency in practices related to monthly worker visits with child(ren) and parents based on case review findings and broaderperformance data (department child welfare data reports and Child Welfare Data Dashboard).

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Well-being Outcome 2: EducationWell-being Outcome 3: Physical and mental health

The final two outcome areas focus on the well-being of children involved in the child welfare system. Three performance items are used to measure outcome achievement, including assessing and addressing:

• educational needs of the child(ren)• physical health of child• mental/behavioral health needs of child(ren).

In the 2015 case review, agency performance in educational needs was rated as substantially achieved in 80 percent (4/5) of the cases reviewed. Which is slightly lower than previous performance of 100 percent (6/6) in 2011.

For Well-being Outcome 3, physical and mental health are measured by two separate items. All applicable cases were rated as a strength and the outcome was rated substantially achieved.

Broad Performance

Broad performance specific to this area is drawn from the Child Welfare Data

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Dashboard:

• Physical Health: In calendar year 2013, the agency’s broad performance was at 52.3 percent for completion of physical health exams. The state goal of 70 percent was not achieved. In quarter 3, the agency’s performance was 32 percent (16/50), and for quarter 4, 40.4 percent (19/47), which was below the state goal of 70 percent for both quarters.

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Case Review

Practices that supported comprehensive attention to children’s well-being needs in the cases reviewed included:

• Ongoing relationships with schools, efforts to maintain child(ren) in home school districts, or to ensure immediate enrollment with academic records following them in a timely manner

• Medical/dental exams and well-child check-ups, follow-up care is available, accessible and children’s needs are fully met

• Mental health screenings were conducted in a timely manner• Mental/behavioral health assessments were thorough, and services to address

identified needs were available and accessible, and children’s needs were fully met.

One case was rated as an area needing improvement. This rating was due to delays in case closing and gaps in worker visits, which resulted in unmet educational needs being addressed ongoing for seven months.

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The left side of this slide reflects the systemic factors that supported achievement of safety, permanency and well-being outcomes for children and families.

The right side of the slide identifies systemic factors that are identified as key strengths to support outcome achievement, as follows:

• Service array capacity to meet families needs is accessible and available to aide them in addressing identified goals.

• Agency responsiveness to community needs. The agency has an active Citizen Review Panel, which meets on a regular basis and discusses community needs, identifying ways to resolve issues in collaboration with the agency.

The left side of the slide lists systemic factors that are identified as agency challenges, such as:

• Supervisor and social worker resources. Lack of resources impacts agency ability to meet timely responses to:• Maltreatment• Re-entry• Achievement of placement stability• Achievement of permanency and adoption timelines• Provision of consistent visitation with parents and children to assess risk

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and safety• Completion of mental health screening tools.

• Foster and adoptive home licensing approval and recruitment. ICPC impacts achievment of timely adoptions.

A recommendation will be made that a PIP include action steps focused on improving the quality assurance review system.

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This slide lists overall strengths, as well as challenges, that result in Program Improvement Plan recommendations.

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Next steps include:

• Meeting with agency administrator to begin work on the Program Improvement Plan• The initial draft version of the PIP will be submitted to the department in 30 days• Once approved and finalized by the department, all documents (self-assessment,

final report and PIP), will be posted on the department public website• Quality Assurance Unit staff will continue to work with the agency to implement the

PIP, and the agency will submit quarterly updates• The agency’s next review in anticipated to be in 2019.

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