And so

4th Quarter and Annual

2010In Broward County every year, several hundred children enter the child welfare system due to abuse, abandonment or neglect. As the local Community Based Care lead agency, ChildNet manages the local system of services and supports for Broward's most vulnerable children. Our mission is to protect Broward's abused, abandoned and neglected children.

Case Management Base, Side-by Side and In-Depth Review, FY 2009-2010

CHILDNET, INC.

CASE MANAGEMENT BASE AND SIDE-BY-SIDE REVIEW REPORT

TABLE OF CONTENTS

Date of 4th Quarter Review and Period under Review …………………. Page 2

Methodology …………………………………………………………………… Page 2

Analysis of Case File Review Data ………………………………………… Page 2

Case Management Practice Trends………………………………………… Pages 3-5

Areas of Excellence…………………………………………………………… Pages 5-7

Opportunities for Improvement …………………………………………… Page 7-8

Quality Improvement Plan (QIP) Progress Findings …………………… Page 8-11

ChildNet In-Depth Base Review Findings ……………………………….. Pages 11-17

DCF In-Depth Side-by-Side Review Findings…………………………….. Pages 17-20

Requests for Action (RFA) ………………………………………………….. Page 20-21

Comparison of Current Findings and Prior Performance Review Findings… Page 21

Summary and Recommendations ………………………………………… Page 21-22

Annual Summary of Quality Assurance Reviews……………………….. Page 23-30

Annual Quality Improvement Plan (QIP) Progress Findings………… Pages 31-32

List of Standards and Data Roll up ………………………………………. Pages 33-43

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Date of Base Review: April 19, 2010 – April 23, 2010 Date of Side by Side Review: April 26, 2010 – April 30, 2010 Period under Review: July 1, 2009 –April 30, 2010 Methodology Twenty-five (25) cases were reviewed during the fourth (4th) quarter review period and from the twenty-five (25) cases eight (8) were randomly selected by the Department of Children and Families’ (DCF) Regional Quality Assurance office for Side-by-Side review. The remaining seventeen (17) cases were used for the Base Review completed by ChildNet’s Continuous Quality Improvement (CQI) department and Client Services staff. The twenty-five (25) cases reviewed were: Maintain and Strengthen (8); Reunification (8); Adoption (4); Kinship Care (3) and APPLA (2). All twenty-five (25) cases were reviewed for specific indicators utilizing the standardized DCF electronic tool to determine whether safety, permanency and well-being were achieved for the children under review. An in-depth Review was also completed on four (4) cases selected from the twenty-five (25) cases; two (2) from the base sample and two (2) from the side-by-side sample. The In-Depth Review consisted of case specific interviews with the focus child as well as other individuals, such as Child Advocates, caregivers, service providers, and other child care staff, who were or are currently involved with the child under protective supervision. Analysis of Case File Review Data ChildNet’s overall fourth quarter performance in achieving safety was 83.5%, a 3% decrease from the previous quarter. The overall performance in achieving permanency was 82.5%, a 4% increase from last quarter. Regarding child well-being, the overall performance was 71.3%, a 15% decrease from the two previous quarters. The overall performance for all of the quality practice standards was 79.1%, a 4.6% decrease from last quarter. **Data for the 1st quarter of the current fiscal year is not available due to a temporary suspension when ChildNet collaborated with DCF on psychotropic medication reviews. Please note based on the limited sample size (twenty-five cases each quarter) the comparison is lacking statistical significance; but the yearly total illustrates statistical significance (see pg 32).

86.5% 86%83.5% 80.5% 79% 82.5% 83.7% 83.7%

71.3%

83.6% 82.9%79.1%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Safety Permanency Well Being Overall Practice Standards2nd QRT 3rd QRT 4th QRT

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Case Management Practice Trends Assessment: Initial Family Assessments averaged 83% (5/6) for completion while the Six Month Family Assessment averaged 21% (5/24). This is a 61% improvement from 3rd quarter (8%). A safety assessment was conducted of a home prior to a reunification or placement in an unlicensed placement in 100% (9/9) of cases and concerted efforts were made during post-placement supervision to manage the risks following reunification and prevent re-entry into out-of-home care in 83% (5/6) of the cases. Multi-disciplinary staffings/assessments were conducted before each placement in 85% (6/7) of the cases. In cases involving a child in a licensed placement setting, an exit interview was conducted in half of the case reviews (2/4). No information was found in the review documenting any extenuating or extraordinary circumstances that inhibited completion of exit interviews in these cases. Ongoing assessment of the children’s needs was achieved in 88% (21/24) of the cases; 86% of the mother’s (18/21); 100% of the father’s (16/16) needs and 100% (18/18) of the out-of-home caregivers. ChildNet achieved 62% (8/13) on ensuring the child’s educational needs were assessed. The child’s educational needs being assessed declined by 28% from 3rd Quarter (86%) to 4th Quarter (62%). The child’s physical health care needs were assessed in 62% (8/13) of the cases and the child’s dental health care needs were assessed in 40% (4/10) of the cases. There were five cases in which no physical health assessment was completed and six cases in which no dental assessment was completed and/or the case file lacked documentation of any consideration of and/or efforts to schedule appointments. The child’s mental/behavioral health needs in 66% (11/17) of the cases were assessed. Family Engagement: ChildNet achieved 100% (5/5) in ensuring parents are notified all of placement changes. ChildNet achieved 100% (20/20) in ensuring and maintaining children’s important connections while in out of home care. In 100% of applicable cases, documentation supports that concerted efforts are being made to ensure visitation with parents and 100% of applicable cases ensured visitation with siblings. ChildNet achieved 94% (17/18) as to the mother and 62% (8/13) as to the father in efforts to support parents’ engagement with services through ongoing contact with the parent and at times addressing the barriers that prevented the parent from completing required tasks. 90% (19/21) of the cases documented concerted efforts to encourage and support participation in making decisions about child's needs and activities for the mother and 100% (14/14) documented concerted efforts as to the father.

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Concerted efforts were made to actively involve all case participants in the case planning process in 92% (23/25) of applicable cases. ChildNet achieved 50% (1/2) on ensuring informed consent or a court order was obtained for the use of psychotropic medications deemed necessary by a physician. Case file lacked documentation of an appropriate consent or court order. Service Planning and Provisions: There were four children who were re-abuse and/or re-neglect for both in-home and out-of-home cases; however 100% (4/4) of the children were provided immediate and ameliorative intervention was provided to the child and in 91%(10/11), concerted efforts were made to provide or arrange for appropriate services for the family to protect the child and prevent the child’s entry into out of home care. 100% (24/24) of the children had documentation that service referrals were consistent with the child’s needs and/or assessments relating to safety and 91% (10/11) of the children all immediate and emerging safety concerns were addressed. Concerted efforts were made to identify, locate, and evaluate potential relatives and possible permanent placements for children in 75% (9/12) of applicable cases. In 100% (20/20) of the applicable cases children did not experience more than two out-of-home placement settings during the periods under review and all were planned placement changes in effort to achieve the case plan goal. ChildNet achieved 100% of applicable cases in ensuring the court was informed of placement changes/reasons. . ChildNet achieved a 100% in ensuring children fifteen years of age and older, progress towards successfully transitioning from foster care to independence through regular informative staffings. 100% (3/3) of the teen-aged child had documentation that he/she is afforded opportunities to participate in normal life skills activities. ChildNet achieved 80% (20/25) on the frequency of the services worker’s visits with all case participants and 100% (24/24) on the quality of the services worker’s visits. When educational needs were identified services were engaged in 67% (2/3) of the cases and 50% (1/2) of applicable cases in which services were initiated, services effectively reduced/resolved the focus child’s education needs. When physical health care needs were identified services were provided to 64% (9/14). When dental health care needs were identified services were provided to 43% (6/14). When needs were identified to address mental/behavioral health issues; services were provided in 86% (12/14) and the agency followed up on all treatment plans that were ordered in 92% (11/12) of cases. Promoting Case Progress: ChildNet achieved 93% (14/15) with placement stability and has achieved 83% (5/6) in children who did not re-entry out-of-home care in less than twelve months following a discharge. ChildNet achieved 100% in ensuring the case is designed to achieve permanency and safety and stability through appropriate tasks for the case participants. There were current case plans in 76% (19/25) of the cases and 95% (20/21) of those cases permanency goals were

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appropriate based on the child’s and family’s circumstances. 86% (12/14) of the case plans specifically addressed visitation and/or other contacts with all case participants. Case file documented evidence of ongoing, meaningful communication with service providers to determine the effectiveness of services in 96% (22/23) of cases. Communication between case management and providers was typically documented via receipt of evaluations, progress reports, and/or certificates of completion. ChildNet achieved 88% (14/16) in regards to maintaining the children’s placements within close proximity to parents in order to facilitate frequent visitation and 100% was achieved for children who were not placed within close proximity to parents, it was based on the child’s needs and achieving the case plan goal. Twenty-three (23) percent (3/13) of siblings were not placed together and 67% (2/3) of those cases there was clear evidence separation was necessary to meet the child’s needs. ChildNet achieved 17% (4/23) in ensuring an inquiry to determine if a child was of Native American or Alaskan Native heritage and of the cases that had a completed ICWA form Forty-four (44) percent (4/9) of applicable cases included children who were in out of home care for at least 12 of the most recent 22 months; however a TPR petition had not been filed; however 100% of applicable cases had documentation of a compelling reason for not filing a petition. ChildNet achieved a 100% (4/4) in documenting appropriate steps taken to identify/recruit an adoptive family that matched the child’s needs and appropriate steps taken to process and approve an adoptive family that matched the child’s needs. ChildNet has provided guidance and assistance in developing an educational and career path based on the child’s needs in 100% (3/3) of applicable cases. ChildNet achieved a 96% (24/25) in ensuring Judicial Reviews are being held timely and Judicial Review Social Study Reports providing a thorough investigation and social study regarding all pertinent details relating to the child. Supervisory Review and Oversight: Sixty percent (60%) (15 of 25) cases documented qualitative supervisory reviews. Fifty-two percent (52%) (13 of 25) of the case reviews were completed quarterly and ensured follow through on guidance and direction or documented the reasons the guidance and direction were no longer necessary and sixty percent (60%) (15 of 25) of the cases reviewed considered all aspects of the child's safety, well-being and permanency Areas of Excellence Case Management excelled in several of the areas related to safety, permanency and well-being.

Safety: • 95% (19 of 20) of the focus child in out-of-home care was not re-abused and/or re-

neglected while under supervision.

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• 100% (14 of 14) of the cases indicated that concerted efforts were made to provide or arrange for appropriate services for the family to protect the child and prevent the child’s entry into out-of-home care (in-home cases).

• 100% (24 of 24) of the cases had service referrals that were consistent with the needs identified through investigative and other assessments related to safety.

• 100% (9 of 9) of the cases had a thorough safety assessment of the home completed prior to reunification or placement of the child in an unlicensed out-of-home placement.

• 100% (8 of 8) of the cases indicated that concerted efforts were made during post-placement supervision to manage the risks following reunification and prevent re-entry into out-of-home care (in-home post reunification cases)

Permanency: • 93% (14 of 15) of the cases documented the child's current placement is stable and

appropriate to meet the child's needs with no apparent or significant risks or projections of disruption.

• 94% (17 of 18) of the cases documented that the mother was encouraged and supported to participate in making decisions about her child’s needs and activities.

• 95% (18 of 19) of the cases documented that the current case plan goal was appropriate based on the child’s and family’s circumstances.

• 96% (22 of 23) of the cases the services worker communicated with service providers about the effectiveness of services for involved case participates.

• 100% (20 of 20) of the cases documented the focus child did not experienced no more than two out-of-home care placement settings during the period under review.

• 100% of the cases documented that the parents (5 of 5) and the court (8 of 8) were notified of all placement changes and the reasons for the changes in placement.

• 100% (18 of 18) of the cases documented concerted efforts were made to ensure visitation (or other contact) was sufficient between the child and parents to maintain or promote the continuity of the relationships between them. (applicable to out-of-home cases)

• 100% (20 of 20) of the cases documented concerted efforts were made to maintain the child's important connections. (applicable to out-of-home cases)

• 100% (5 of 5) of the cases documented if a Termination of Parental Rights petition was not filed, there were compelling reasons and an exception was documented.

Well-being: • 90% (19 of 21) of the cases documented concerted efforts were made to support the

mother’s engagement with services. • 92% (23 of 25) of the cases documented concerted efforts were made to actively

involve all case participants in the case planning process. • 100% (20 of 20) of the cases demonstrated the cases are designed to achieve

permanency (out-of-home care cases) and safety and stability (in-home cases) through appropriate tasks for the case participants.

• 100% (15 of 15) of the cases documented an ongoing assessment of the father’s needs was conducted to provide updated information for case planning purposes.

• 100% (14 of 14) of the cases documented concerted efforts were made to support the father’s engagement with services.

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• 100% (18 of 18) of the cases demonstrated ongoing assessments of the out-of-home care providers or pre-adoptive parent's service needs were conducted in order to ensure appropriate care for the child.

• 100% (24 of 24) of the cases documented the quality of the services worker’s visit with case participants was sufficient to address issues pertaining to the child’s safety, permanency and well-being.

• 100% (4 of 4) an EPSDT screening was completed within seventy-two hours. Federal Child and Family Services Review: • 96% (24 of 25) of the cases documented Judicial Reviews were held in a timely

manner and Judicial Review Social Study Reports (JRSSR’s) provided a through investigation and social study concerning all pertinent details relating the child.

Opportunities for Improvement The review also identified some opportunities for improvement, including:

Safety: • 21% (5 of 24) of six-month family assessments focused on the immediate and

prospective safety of the child, as well as any changes and implications in the family’s situation related to emerging concerns and services needs. Please note that the information necessary to complete the family assessment, i.e., safety, changes, emerging concerns and safety needs was located throughout the case file.

Permanency: • 17% (4 of 25) documented that an inquiry was made to determine if the child was of

Native American or Alaskan Native heritage. • 62% (8 of 13) documented the father was encouraged and supported to participate in

making decisions about his child’s needs and activities.

Well-being: • 25% (2 of 8) documented that the service agency followed-up treatment plans that

the doctor ordered when there was an identified physical health need. • 33% (2 of 6) documented that the service agency followed-up treatment plans that

the doctor ordered when there was an identified dental health need. • 40% (4 of 10) documented appropriate services were provided to address the child’s

identified dental health care needs. • 42% (5 of 12) documented that the agency complied with the dental periodicity’s

scheduled pertinent to the child’s age and needs. • 43% (6 of 14) documented concerted efforts to assess the child’s dental health care

needs. • 62% (8 of 13) documented concerted efforts were made to assess the child’s

educational needs and maintain the child within the same school during out-of-home placement.

• 62% (8 of 13) documented concerted efforts were made to assess the child’s physical health care needs and the diagnoses from the physical health care screenings are documented in the case file, medical passport, and/or the child’s resource record.

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Federal Child and Family Services Review: • 60% (15 of 25) documented qualitative supervisory reviews and follow through

were conducted as needed and required to include being completed quarterly; supervisor considering all aspects of the child’s safety, well-being and permanency; and ensuring follow through on guidance and direction.

Quality Improvement Plan (QIP) Progress Findings CFSR Item Measurement based on QA standards Outcome Safety 2: Children are Safely Maintained in Their Homes Whenever Possible and Appropriate.

• Item 3: Services to Family to Protect Child(ren) In-home and Prevent Removal or Re-entry into Foster Care. The three case management standards for Item 3 are: services to protect the child (100%,14/14); service referrals (100%, 24/24) and management of risks (100%, 8/8). The overall performance for all the quality practice standards was 100%.

91.40%

95.20%

100%

86%88%90%92%94%96%98%

100%

2nd Qtr 3rd Qtr 4th QtrItem 3- Services to Family to Protect Child(ren) In-Home and Prevent Removal or Re-entry into Foster Care

Item 4: Risk Assessment and Safety Management. The four case management standards for Item 4 are: initiation of immediate interventions (100%, 3/3); initial family involvement (83% 5/6); immediate and emerging safety concerns (91%, 10/11) and safety assessment (100%,9/9). The overall performance for all the quality practice standards was 93.1%

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87.20%88.60%

93%

84%

86%

88%

90%

92%

94%

2nd Qtr 3rd Qtr 4th QtrItem 4- Risk Assessment and Safety Management

Outcome Permanency 1: Children have Permanency and Stability in Their Living Situations.

• Item 7: Permanency Goal for Child. The case management standard for Item 7 is case plan goals (95%, 18/19). The overall performance for the quality practice standard was 95%.

86% 86%

95%

80%82%84%86%88%90%92%94%96%

2nd Qtr 3rd Qtr 4th Qtr

Item 7- Permanency Goal For Child

• Item 10: Other Planned Permanent Living Arrangement – The case management

standard for Item 10 is the agency made concerted efforts to ensure the child is adequately prepared to transition into independent living and is living in a permanent arrangement until he/she reaches the age of majority (100%- 1/1). The overall performance for the quality practice standard began this quarter.

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100%

0%

20%

40%

60%

80%

100%

2nd Qtr 3rd Qtr 4th QtrItem 10- Other Planned Permanent Living Arrangement

NA NA

Outcome Well-Being 1: Families have Enhanced Capacity to Provide for Their Children’s Needs.

• Item 17: Needs and Services of Child, Parents, and Foster Parents. The six case management standards for Item 17 are: ongoing assessments of the child’s needs (88%, 21/24); ongoing assessments of the mother’s needs (86%, 18/21); engaging the child’s mother (90%, 19/21); ongoing assessment of the father’s needs (100%, 16/16); engaging the child’s father (100%, 14/14) and ongoing assessment of out-of-home care providers (100%, 18/18). The overall performance for all the quality practice standards was 93%.

87.3%

92.2% 93%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

2nd Qtr 3rd Qtr 4th QtrItem 17- Needs and Services of Child, Parents and Foster Parents

• Item 18: Child and Family Involvement in Case Planning. The case management standard for Item 18 is: case planning process- family involvement (92%, 23/25). The overall performance for all the quality practice standards was 92%.

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84.0% 84.0%

92%

80.0%

85.0%

90.0%

95.0%

2nd Qtr 3rd Qtr 4th QtrItem 18- Child and Family Involvement in Case Planning

• Item 19: Caseworker Visits with Child. The two case management standards for Item 19 are: frequency of service worker’s visits (92%, 23/25) and quality of the service worker’s visits (100%, 25/25). The overall performance for all the quality practice standards was 96%.

82% 82%

96%

75%

80%

85%

90%

95%

100%

2nd Qtr 3rd Qtr 4th QtrItem 19- Caseworker Visits with Child

• Item 20: Caseworker Visits with Parent(s). The four case management standards for Item 20 are: frequency of service worker’s visits with the mother (75%, 15/20); quality of the service worker’s visits with the mother (84%, 16/19); frequency of service worker’s visits with the father (64%, 9/14) and quality of the service worker’s visits with the father (93%, 13/14). The overall performance for all the quality practice standards was 79.1%.

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52.3% 55.8%

79.1%

0.0%

20.0%

40.0%

60.0%

80.0%

2nd Qtr 3rd Qtr 4th QtrItem 20- Caseworker Visits with Parent(s)

ChildNet In-Depth Base Review Findings: In-Depth Case #1 The AW case involved a child JB, age three (3) and her mother. JB has five older siblings not on this case that have been previously adjudicated in another county and placed with relatives. The siblings continue to remain in their relative placements. JB was shortly removed after her mother contacted the Abuse Hotline stating she could no longer care for the child, the child was sheltered on 8/14/07. The following individuals were interviewed during this in-depth review: The child’s mother (AW), the child (JB), the child’s current caretaker (a licensed foster parent who would like to adopt the child), the day care provider, the Guardian ad Litem (GAL), the Child Advocate, the Adoptions Specialist and the Termination of Parental Rights (TPR) Specialist. Interviews: The Child Advocate completed the Initial Family Assessment and also completed updated six month family assessments ongoing. The child is presently placed in an identified adoptive placement with a woman who is willing to provide permanency for this child. The Child Advocate has been assigned twice to this case as this case was transferred to another worker and transferred back once the previous worker left the agency. The Child Advocate referred the mother to parenting, anger management, individual counseling, random drug screenings, and a psychological. The Child Advocate reported that the majority of these services were paid for by ChildNet; however once the mother became non-compliance with services; ChildNet would not pay for any additional services. The Child Advocate visits the child monthly and feels her current placement is an appropriate and healthy placement for this child. The Child Advocate also stated that the mother frequently fails to appear for her visits with her child. The mother has also been provided with updates on any medical visits and evaluations the child has been scheduled for. The Child Advocate reported that relatives were explored and none were found appropriate for placement. The GAL stated that she is always kept well informed of all events in this case. She stated, “The Child Advocate is one of the best Child Advocate’s I have ever worked with.” The GAL supports the child’s goal of Adoption and described the child’s first licensed placement as one that the child received very little love and affection. “The foster parent was just collecting a check.” The child now has none of the issues she had in the previous foster home, especially

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around food. The GAL reported that the mother has been referred to lots of services but she is often “kicked out.” The GAL reported the child has remained in the same day care since date of removal. The TPR Specialist shared that the mother’s five children were previously removed and placed with relatives and was closed to Permanent Guardianship. This worker stated that the mother failed to complete any of her required case plan tasks. She isn’t consistent with random drug screenings and when she is she generally tests positive. She is also inconsistent with her visits with her child and displays poor anger management control. The TPR Specialist reported that she felt medication management might possibly assist the mother with her behaviors and self-control. The TPR Specialist felt that jurisdiction should have remained in another county and perhaps that would have helped the case move forward quickly. The Adoption Specialist felt the goal of Adoption for this child was appropriate. She went on to say that the biological mother has rarely seen this child and in observing a visit between the mother and the child, the child was more bonded to the Child Advocate as evidence of hugging the Child Advocate the entire visit then her mother. The Adoption Specialist reported that she has frequent contact with the pre-adoptive mother and also trained her in Model Approach to Positive Parenting (MAPP). She reported the adopted mother is very open to any service available for this child and strongly felt this placement is very appropriate for this child. The child’s current foster parent was interviewed with the child in her home. The foster parent described the child as friendly, fun loving and a quick learner who doesn’t give her any trouble. The foster parent reported she transports the child to all her medical appointments and evaluations. She also stated that she had no desire to meet the mother due to all what has been reported to her from all of the workers. The foster parent reported she has never gone to any court hearings and has not attended any staffings. The foster parent reported that the child is getting everything she needs in her care. She described her overall experience as a new adoptive/foster parent as pretty good. MAPP classes were a good experience and the follow-up she receives from her Adoption’s worker is excellent. The child appeared to be happy, healthy and bonded to this pre-adoptive parent. The daycare provider is a home daycare provider. The provider has been the provider for the child since the date of removal, approximately three years ago when the child was five months old. The daycare provider reported that the child’s current placement is a much healthier environment than the one she left. She reported the child had eating issues in the other home, where she would vomit a lot and the child would also cry uncontrollable. The daycare provider reported that when she moved to her present adoptive/foster home she was potty trained in a week, she came out of her shell and is much more loving. She also stressed that communication with the new foster parent is excellent in comparing her experience from the last one who lacked in communication and follow up. The daycare provider reported that her current foster parent is very involved in the welfare of this child. The last interview involved the child’s mother who is currently living out of county. The mother presented very emotional during the evaluator’s visit as evidence of several crying outburst. She spoke using profanities and discussed how impossible it was for her to complete the expectations of the agency. The mother reported she was in a long-term relationship with the father of her other child who was physically abusive. The mother reported her youngest child was removed as her other children had been previously removed. She described the impossibility of her situation which included an extensive amount of tasks and still having to keep a job. The mother reported visits were truly difficult given the fact of how far she lived from

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the child and when she requested Saturday visits, they were denied. The mother reported her child never had physical issues until she was placed in foster care; being sick, underweight and her hair falling out. She described her past as one that involved illegal activities in order to support her family. She reported she only cares for her children and that her extended family is dysfunctional. “My addiction is that I was addicted to an addict. I have always placed my children first, none of them were drug exposed at birth and all remain healthy.” The mother reported that the parenting classes do not teach you how to take care of children. The mother strongly felt that no one in the system was helping her with all the obstacles she encountered in order to complete her case plan tasks and be reunited with her child. The mother reported the difficulty of getting to a provider in Broward County on a bus due to the distance from another county and reporting being “kicked out” of the program when she arrived fifteen minutes late twice. The mother described her courtesy worker as a great support to her but that no one in Broward County were there to support her. Strength: The child is presently placed in an identified adoptive placement with a woman who is willing to provide permanency for this child. The child has been in the same daycare provider since the date of removal. Areas needing improvement: The mother, the child’s siblings and all known relatives all live out of county. The child was sheltered in Broward County as this is where the mother made the call to the hotline from when she lived briefly in that county. There is little evidence in the documentation that much was done to locate possible relative placements or to suggest moving the jurisdiction of the case to the county the mother and relatives live in. Due to the mother’s limited income, it was difficult for her to have visits with her child or to attend staff meetings at ChildNet and/or to attend court hearings. Supervisory reviews were not completed quarterly during the period of review; there was no determination made to acquire whether or not the child was from Native American heritage and no concerted effort were made to get the mother’s involvement in the case planning process. While the case file documents that there were several doctor’s appointments made, there was no evidence the child attended these appointments as indicated in the case record. The case file documented in an evaluation the child had (Reactive Attachment Disorder (RAD)-like symptoms and that she could benefit from speech therapy; however the case file had no evidence that there was completed. In-Depth Case #2 The BP case involved a child (JT), age two (2), mother (signed surrenders on 8/13/09, which the court accepted on 10/20/09), father (whose whereabouts were unknown during the entire period under review and his parental rights were terminated) and maternal grandmother. The child was removed from the mother’s physical custody due to domestic violence and placed in the maternal grandmother’s custody on 8/12/08. The mother was a young teenage mother who also resided in the same home along with the child’s aunt (14 years old). The child (JT) had no siblings on the case. The following individuals were interviewed during this in-depth review: The child (JT), the child’s current caretaker (an adoptive relative placement), the day care provider, the Guardian ad Litem (GAL), the child’s Child Advocate, the Adoptions Specialist, the Termination of Parental Rights (TPR) Specialist and Attorney General’s Lawyer. Interviews were not scheduled with the parents as both of the parent’s rights have been terminated. Interviews:

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The Child Advocate reported that she was assigned to this case in May 2009. She reported that BP is a young mother, approximately nineteen years old, who used to live in the home when she was first assigned the case but moved out when she signed surrenders. The Child Advocate reported that she was not assigned the case when the case plan was developed with the mother. She also reported that the mother did complete some of her case plan tasks to include complying with individual therapy and probation. However, the mother reported that it was too much to take care of kids. The Child Advocate reported that when the mother was living in the home she has observed the mother giving the child a bath and the interaction was appropriate. The mother has also requested information on obtaining a GED; however when the Child Advocate provided the mother with the information she was not motivate to follow through. The Child Advocate also reported that she visits the child at least every thirty days. The Child Advocate reported that during her home visits she walks through the home, asks the maternal grandmother how the child is doing in the home/school and observes the interaction between the child and the caretaker. I also ask the caretaker if the child has had any medical appointments since the last visit and whether or not she is in need of any services. The Child Advocate reported that she attempts to interact with the child during home visits; however the child is very shy. The Child Advocate reported that she assisted the maternal grandmother in obtaining relative caregiver funds and that the maternal grandmother schedules/transports the child to all appointments and attends all court hearings. The Child Advocate reported that the child may need speech therapy; however the maternal grandmother did not feel he needed it. The Child Advocate ended by stating, “I love working with this family. The maternal grandmother and aunt are really good with the child.” The Child Advocate reported that the child is in the process of adoption with the maternal grandmother, which is the only home the child has ever lived in. The Adoption Specialist felt the goal of Adoption for this child was appropriate as the child’s mother is very immature and was not meeting the child’s needs. The Adoption Specialist reported that she has conducted two home visits, in which she discussed adoption services and provided an overview of the adoption process with the maternal grandmother. The Adoption Specialist reported the Adoption homestudy is currently in the process and felt the maternal grandmother did really well in sharing and also went to great lengths in providing her a lot of family background and information in the form of a letter. The Adoption Specialist did report that the maternal grandmother would lose subsidized daycare through family central, but states that the maternal grandmother is a bright and resourceful lady and is also open to following up with Post Adoption Services if necessary. The Adoption Specialist did report that the Child Advocate had a hard time getting and communicating with her; however she has been responsive to any request for documentation. The daycare provider interview was the child’s teacher in the mornings. The teacher reported that child has been attending this daycare since he was an infant. She reported that she is currently teaching the child to identify colors and numbers. The teacher reported the maternal grandmother is very engaged in the child’s welfare and always wants to know how the child did in school. The teacher reported that the child is a happy child, always arrives clean, has good fine motors skill, his attention span is very active and felt that the child could benefit from speech therapy due to the child having a very limited vocabulary; however the maternal grandmother informed her that she did not see anything wrong and at home the child does say more words. The teacher reported that she is unsure whether the maternal grandmother has taken the child for a speech evaluation but that the child had an evaluation for his Gross and Motor skills which not concerns were noted. The teacher also reported that she has seen a growth in the child and felt that being in preschool was helpful to him. The teacher reported that

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the Child Advocate has never visited the daycare facility or contacted her and has never been invited and/or attended any staffings at ChildNet. The child was also observed in the daycare setting. The child was clean and appeared free from any visible marks or bruises. The child would smile at this writer but would not speak. The TPR Specialist shared that the she has never met the child, met the mother once and that she sees the maternal grandmother at every court hearing. The TPR Specialist reported that once the final judgment is signed she is no longer involved with the case. The TPR Specialist felt that the mother was provided with all needed services, but the mother reported she was not able to do all of the services. The TPR Specialist reported the mother was very young and was at a stage in her life where she wants to live out her life with no responsibilities. The mother was very cooperate in signing surrenders even after being told that her mother would not necessary be the adoptive choice for the child. The TPR Specialist reported that the mother did move from the home when instructed that the maternal grandmother would not pass an adoptive homestudy with her in the home. The TPR Specialist reported that this case had no issues and/or struggles doing the termination of parental rights process, the mother was cooperative and did not give the agency a hard time. The TPR Specialist reported the Child Advocate had all services in place for the child, would follow up quickly on requested items and would always stop by my office for assistance in filling out certain documents. The TPR Specialist reported that she always had open communication with the Child Advocate on the case. The Assistant Attorney General reported that he was assigned to the case during the termination of parental rights process from 11/5/09 – 3/23/10. The Assistant Attorney General reported that the mother signed surrenders right before he was assigned and the only dealings he had with the father was through an Affidavit of Diligent Search and he did not response to the newspaper listing. The Assistant Attorney General reported that he was never invited nor attended any staffings at ChildNet and only communicated with the TPR Specialist mostly though email. The Assistant Attorney General went on the state that he did not have much input on this case as this is one of the easiest cases he has ever had. The Guardian Ad Litem (GAL) reported she has been assigned to the case since December 2008 and described herself has a pretty proactive GAL. She reported that she visits the child at least once a month and maintains regular phone contact with the maternal grandmother. The GAL reported that the maternal grandmother contacts her with all of her concerns on the case and especially when she is unable to get a hold of the Child Advocate. The GAL supports the child’s goal of Adoption and described the maternal grandmother as excellent and very good at meeting all of the child’s needs. The GAL reported that the maternal grandmother follows up with all services and/or medical appointments for the child. The GAL reported that the child has had a lot of ear infections and felt that could be a reason for his limited speech; although the maternal grandmother is open to services the maternal grandmother felt that the child would not talk to a stranger. The GAL reported she has never observed any visits between the child and his mother and that since the mother has moved to north Florida with her grandmother they have been no visits between the child and the mother. The GAL felt that everyone on the case did everything they could to assist the mother and reported the mother was referred to an array of services, but that the mother was very young and immature and lapsed on service referrals. The GAL reported that she has been invited by the Child Advocate to staffings at ChildNet, but that they were always last minute usually a day or two before the staffing.

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The last interview involved the child’s current caretaker, the maternal grandmother and observation of the child. The child was eating dinner and watching cartoons when this writer and co-worker arrived. The child interacted with his aunt (14 yrs old) and appeared bonded with his maternal grandmother as evidence of the hugging. The child was clean and had no visible marks or bruises. The child appeared to be happy, healthy and bonded to this maternal grandmother. The child would not talk; however when this writer threw a ball he would get it and throw it back. The maternal grandmother reported that her grandson has lived with her since he was four months old and she has been his primary caretaker. She reported that she takes him to all medical appointments and she is happy to know that she will be the one to raise him to go to college. She reported that the child participated in an evaluation; however he was shy and hide under the table. The maternal grandmother reported his Gross and Motor Skills was tested and that the school is rescheduling a speech appointment during her lunch hours. She reported she is not concern with his speech and feels that the child is just being lazy and choosing not to speak. The maternal grandmother reported she is a mother of two daughters (14 and 19) and her oldest daughter is the mother to her grandson. The maternal grandmother reported that she is kept informed of all staffings and attends all court hearings. The maternal grandmother stated, “even when I am told I do not have to be there” I still attended. She reported that the Child Advocate visits once a month, during the first week of the month for approximately two years. During the visits the Child Advocate will talk to the child; however he really doesn’t engage. The maternal grandmother reported that she recently moved from another residence to her current apartment and only remember the Broward Sheriff’s Investigator conducting a homestudy at the time of removal. She reported that no one has come to complete a new homestudy at her current residence. The maternal grandmother reported that the GAL visits regularly and that she participated in two interviews with the Adoption Specialist. The maternal grandmother reported that she currently receives relative caregiver funds; however there was a major delay in her receiving the funds. She reported that the Child Advocate failed to complete the necessary paperwork and several months went on without any compensation. She also reported that her Child Advocate reported that since her daughter, the mother to the child resided in the home she did not qualify for the relative caregiver funds. The maternal grandmother reported that she felt she did not need any additional services or training as she was the Director of the daycare the child currently attends for approximately ten years and has had numerous parenting classes. The maternal grandmother reported some concerns with the assigned Child Advocate in reference to the worker insisting that she change her grandson’s name and to have the child start calling her mom instead of grandmother. The maternal grandmother was really upset in reference to the aforementioned as she strongly believes that child already has a mother and she will always be his grandmother. The maternal grandmother also expressed that it has been two years that her family has been involved with the entire process and felt that it was a very long time to finalize an adoption. The maternal grandmother also questioned how the Adoption Specialist could make an informed decision on her capability to be an adoptive parent by just asking her questions on how she was raised. She wanted to know why the Adoption Specialist does not set up meetings during a park visit or another activity in which she could observe her interaction with the child and felt concern about the adoption process for children who were being adopted by non-family members. At the end of the visit the child did give this writer a ‘high five’. Strength: The child has been in the same placement the entire length of the case and the caretaker is in the process of adoption. Medical records where in the case file and the caretaker complied with the periodicity scheduled pertaining to the child’s age. The Child Advocate ensured visits were conducted with both the child and caretaker every thirty days. The current case plan in the file had individualized tasks and/or services for the case participants.

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Areas needing improvement: An ongoing six month Family Assessment was not completed on this case. The last Family Assessment was completed on October 3, 2008. Supervisor reviews did not document follow up on guidance and/or recommendations provided. An updated homestudy was not completed on the maternal grandmother’s new residence at the time of the interview. Both the visitation forms and FSFN listed the maternal grandmother’s previous residence as the child’s current home address. This generated a Safety Request for Action form. DCF In-Depth Side-by-Side Review Findings: In-Depth Case #1 The AA case involved a single mother (AA), two children focus child DA age 5, and his younger half-brother age 2. The case came into care because of Domestic Violence between mother and father of focus child children were initially removed, but court returned the children to the mother under protective supervision at the Shelter hearing. While under court order protective supervision a subsequent Domestic Violence incident occurred between mother and father of the youngest child. Since mother had not followed through with her services particularly relating to Domestic Violence issues, children were re-sheltered in March 2010 out of concern of threatened-harm and mother possibly failure to protect as a result of her lack of follow through with services. Since the removal the mother has been complying with her tasks and the case plan goal is reunification, and she currently has unsupervised day visits. The father of DA has not been involved with any of the dependency proceedings, the father of the sibling is in compliance with his case plan tasks, but he is not in a position to care for his child. Maternal relatives were explored as a placement resource, but did not meet the home study/ background check requirements. The following individuals were interviewed during this in-depth review: the child, the day care teacher, the current licensed foster parents, the 4Kids Support Worker, the Child Advocate, and the Child Advocate Supervisor. Interviews were attempted with the mother, but she failed to show for three scheduled appointments and did not call after missing last appointment nor returned any of this reviewers phone calls. Interviews: Child DA was observed in class at his day care, reviewer was able to speak with child by himself in a designated room provided by the day care administrator. Child was observed to be free of any visible marks or bruises indicative of abuse on his visible extremities. DA was very friendly and unafraid to speak with me, he appeared developmentally normal for his age, stated he and his brother used to live with his mommy and his brother’s dad. Child was not oriented to dates or time when asked how often he visits his mother, but states that he does see her. He did not know the reason why he was in foster care. Child states he goes to the doctor and said he went to the dentist. Child states he likes his current foster parents, but wants to go live with his mother. Time to Care Daycare Teacher, states DA started attending there since March 2010. States he attends daily and she is aware that he is in foster care. States DA gets along well with the other children; he is well behaved, mannerly, and states he is on the same level with the other children his age.

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Foster Parents: were both observed and interviewed in their home. States DA and his brother were placed with them since their removal in March. States children are well mannered and have adjusted well to the foster parents. States DA has verbalized that he wants to go back to his mother. The foster parents allows mother to have telephone calls with the children during the week and foster mother drops off and picks up children at a designated location for the mother to take children on Sundays for her unsupervised visits. States mother is not very respectful of the time; she is usually late either picking up or dropping children off. Foster parents states would like to see children reunified with their mother if court determines that is in their best interest. 4Kids Support Worker: states their agency license the foster parents and that these foster parents are very appropriate. The support worker states she is required to visits home at least every three months, but in actuality visits much more often. States does the re-licensing and ensures foster parents receive continuing education. States she has a good working relationship with CN’s CA they work together to ensure that children’s needs are being met. States feels reunification is an appropriate goal, but thinks family will need intensive wrap-a-round services after reunification occurs to ensure ongoing success of the family. CAS/ CA: both were interviewed jointly, with the CA present by phone because he had to go to court. The case was recently reassigned to this CA because the previous CA who had been on the case since the inception was out on extended medical leave. The both the CAS and CA were well acquainted with the case as it turns out the mother was in foster care and the current CA was her case manager when she was the dependent child. States A.A. is young mother in her twenties; she had not always been compliant with her case plan tasks and only started complying after the children were removed. States the mother still has to obtain stable employment, states she has kept her apartment, but has not provided of how she affords it. CAS/CA suspects that mother is back with father of focus child and that he helps her finically. States mother is guarded and not totally forth coming with information. States father of focus child has not appeared in court and father of the sibling has complied with court tasks however he is not able to care for child. Maternal grandmother and aunt were explored as relative caregivers, but they did not pass home study/background checks. Worker visits children at least every 30days in foster home, but on see mother at court hearings or talk to her by phone. Strength: The siblings are placed together and have remained in the same foster home since their current removal in March 2010 and appear to be well care for. The foster parents are committed to caring for the children long term as needed. The mother is complying with meeting her case plan task. Areas needing improvement: The CA should begin monthly visits with the mother at her home since the goal is reunification. Although mother is complying with her task, she appears somewhat resistant or guarded and does not seem to be totally forth coming about her relationship with the father or fathers of her children. CA/CAS should probably have mother come to office to have a heart to heart talk and get to the bottom of some of the questionable activities (e.g.) how is she currently paying her rent, ask for a copy of her lease, etc. They should try to ascertain if the mother is back with the father of DA and address concerns regarding court and any case plan tasks he may need to complete. Even if it turns out that mother is not residing with DA’s father, CA should explore if there is any significant person she is involved with and conduct background checks to assure clearance since mother has unsupervised and children are permitted to spend time with her at her home. CA should also address with mother’s disregard for foster parent’s time when picking up or dropping off children for her unsupervised visits. CA should also address mothers disregard for keeping the three

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appointments that were a no show with this reviewer. Overall it appears mother has a lack of respect for authority or the system and unless this is addressed it may present a challenge for the agency to get her to cooperate once the children are returned. She may have complied with some of her tasks, but their appears to be little evidence of any change in her attitude or behavior as it relates to her reasonably cooperating with the system In-Depth Case #2 The H.R. case involved the mother and father who are separated, and their three minor daughters. The focus child SR age 10 is the eldest of her two sisters. The family is under court ordered supervision; the children are in the custody of the mother and the father has unsupervised visits. The case came into care as a result of allegations of Domestic Violence and substance misuse of prescription drugs. This in-depth consist of an interview with the Child Advocate, Child Advocate Supervisor, and the mother. Telephone visits were scheduled with the GAL, SURF therapist, but there was a conflict with the appointments and they were not successfully rescheduled as the date of this writing. Interviews: Child Advocate: states she has been assigned to the family since the inception of their case July 13, 2009. States both parents were almost in compliance with their case plan tasks, but the mother was subsequently court ordered to obtain a psychological evaluation which resulted in recommendations of additional services for the mother. The father is in compliance with all his tasks and he is permitted to have supervised visits with the girls each week. The CA states mother is always in a crisis and CN has had to assist her with rent and utilities on more than one occasion. CA states she makes face-to-face home visits at least every 30 days, but actually goes to the home more often because mother is very needy. The father has complied with his case plan tasks and wants no involvement with the system if it is not mandated by the court, there for no visit was scheduled with him. The children attend public school, and they receive individual and family therapy. States the mother and father do not get along, but the children enjoy spending time with their father. Child Advocate Supervisor: States that she has had the case in her unit for a since the inception of the case. The mother has takes prescription medication for a past back injury. The mother solely relies on the child support payments from the father and as a result she has had problems managing her financial affairs. The mother has been advised to apply for disability, but has not been successful because she ‘doctor shops’ for her prescription medications. The mother has had additional tasks added as a result of her psychological evaluation. Stated the mother is very needy and they are trying to work with her to get her to be self sufficient. Biological Mother: The biological mother was interviewed and confirmed that the Child Advocate comes to the home and visits the children at least monthly, but usually more often. States she is upset that ChildNet repots she has not completed her tasks, but reports to the court that her husband has completed his tasks. She had a psychological evaluation and it was recommended that she have a psychiatric evaluation. She blames ChildNet for not setting the psychiatric appointment sooner and blames the husband for the reason for her case being open. She states they she attended mediation, but denies participating in the development of her case plan tasks. She states the children are fine, but sometimes act up yelling not listening to her after they come back from visiting their father. States ChildNet helped her with her rent

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and light bills and she has friends across the street for her support system. The mother appeared fickle, her conversation was jumbled and she had to be redirected back to this writer’s questions. She appeared to have been fixated on finding fault with the husband and not willing to assuming any responsible for her actions or lack thereof. Strength: The children have two parents and both parents appear to be committed to the children. With help from ChildNet funds were secured to help mother and children retain their housing and keep utilities working. The children are all school age and are visible to the community. The father provides child support to the family. Areas needing improvement: The mother appears to be very needy and always in crisis mode. Both parents have an adversarial relationship and are not able to put aside their differences for the sake of the children. The mother needs to be empowered so that she can stand on her own two feet because it is not realistic for her to expect to be bailed out of her financial dilemma on a repeated basis. Although both parent are in compliance with their case plan tasks it is unclear whether the services they have and/or are receiving has had any positive impact on their behavior. Requests for Action A Request for Action (RFA) form is completed for cases involving child safety or administrative concerns needing review or follow-up. There were ten cases in which a Request for Action form was completed. Request for Action forms were completed regarding the following areas of concern:

An inquiry was not made to determine if the child was of Native American or Alaskan

Native heritage. (6 cases)

Qualitative supervisory reviews and follow through were not conducted as needed and

required. (6 cases)

Six month family assessment was not completed. (5 cases)

The case record did not contain a current (not expired) case plan. (5 cases)

Concerted efforts were not made to assess the child’s physical health care needs. (5

cases)

Concerted efforts were not made to assess the child’s dental health care needs. (5

cases)

Concerted efforts not made to identify, locate and evaluate other potential relatives and

possible permanent placements for the child. (2 cases)

Concerted efforts were not made to actively involve all case participants in the case

planning process. (1 case)

Concerted efforts were not made to assess the child’s mental health needs. (1 case)

The diagnoses from physical health care screenings are not documented in the case file,

medical passport, and/or child’s resource record. (1 case)

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Appropriate services were not provided to address the child’s mental/behavioral health

needs. (1 case)

Failure of completing a safety assessment of the home (homestudy) prior to a placement

of a child in an unlicensed home. (1 case)

Concerted efforts were not made to assess the child’s educational needs. (1 case)

Missing the implementation of a safety plan. (1 case)

All of the Request for Action form’s resulting from this review have been resolved and closed. Comparison of Current Findings and Prior Performance Review Findings ChildNet has participated in three quarterly reviews of twenty-five cases; for a total of seventy-five cases. ChildNet did not complete a 1st Quarter review due to the agencies participation in psychotropic medication reviews. The comparison data for each quarter is presented in the last section of this report. The comparison of data based on the limited sample size, shows similar findings in over-all performance. Continued efforts need to occur to improve in the areas listed in the next section in regards to Safety, Permanency and Well-being. Summary and Recommendations The overall performance in achieving Safety 81%, Permanency 82% and Well-Being 83% are below the 90%, which should be raised to meet the current projected CFSR performance range of 95%. More specifically the following areas under each should be carefully evaluated and strengthened to raise ChildNet’s overall performance achievements.

Safety:

• Six-month family assessments must be completed, focusing on the immediate and prospective safety of the child, as well as any changes and implications in the family’s situation related to emerging concerns and services needs.

• Although documentation existed in the case file to address these issues, they were not transferred to the Family Assessment in FSFN.

Permanency:

• Strengthen documentation of all quarterly supervisory reviews by considering all aspects of the child's safety, well-being and permanency; and ensuring follow through on guidance and direction and/or documented the reasons the guidance and direction were no longer necessary.

• Continue to strengthen documentation of all inquiries to determine if the child was of

Native American or Alaskan Native heritage. Subsequently, BSO has been instructed to include the ICWA form 5323 in their removal packet, and all ChildNet supervisors were instructed to complete any needed currently on existing cases.

Well-being: • Ensure Child Advocate is having visits with parent(s) at least every thirty days when the

goal is reunification; and strengthen documentation of all visits with parent(s) or at least document efforts made to visit with parent(s).

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• Ensure documentation is maintained in the case file of the child’s physical, dental and mental health assessments, ensure any additional service needs and document followed-up on treatment plans that the doctor ordered.

• Strengthen documentation of communication with the child’s parent or guardian to

ensure parental awareness of the need to provide express and informed consent for the prescription of each psychotropic medication.

Annual Summary of Quality Assurance Review Findings

Case Management Practice Trends Assessment:

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Initial Family Assessments averaged 85% (22/26) for completion while the Six Month Family Assessment averaged 18% (13/74). There was a 61% improvement between 3rd quarter and 4th quarter. There is ongoing opportunity for improvement in ensuring the Six Month Family Assessments are completed. Continued efforts are needed to ensure that they adequately reflect an assessment of immediate and emerging safety concerns pertaining to the family. Additionally, it is critical that they are updated at least every six months and at critical junctures in the case, such as when new reports of abuse and/or neglect are received or when there are changes in family factors. ChildNet continues to do well with placement safety assessments. A safety assessment was conducted of a home prior to a reunification or placement in an unlicensed placement in 91% (30/33) of cases and concerted efforts were made during post-placement supervision to manage the risks following reunification and prevent re-entry into out-of-home care in 95% (20/21) of the cases. Multi-disciplinary staffing/assessments were conducted before each placement in 77% (20/26) of the cases. In cases involving a child in a licensed placement setting, an exit interview was conducted in half of the case reviews. Exit interviews continue to present an opportunity for improvement. This standard was applicable in fourteen cases and half of them were not completed. Achievement for this standard was at 50% during each of the three quarters under review. No information was found in the review documenting any extenuating or extraordinary circumstances that inhibited completion of exit interviews in these cases. ChildNet continues to do well ensuring ongoing assessments of all participants for the case planning process. Ongoing assessment of the children’s needs was achieved in 92% (68/74) of the cases; 88% of the mother’s (52/59) and father’s (38/43) needs; and, 98% (56/57) of the out-of-home caregivers. ChildNet achieved 85% (39/46) on ensuring the child’s educational needs were assessed. The child’s educational needs being assess has declined each quarter and declined by 28% from 3rd Quarter (86%) to 4th Quarter (62%). The child’s physical health care needs were assessed in 85% (39/46) of the cases. The child’s dental health care needs were assessed in 51% (23/45) of the cases. There is an ongoing opportunity for improvement in regard to concerted efforts to assess the child’s dental needs. This standard was achieved in 51% of cases during this review. There was a 39% improvement in comparison to achievement of this standard between the 3rd Quarter (31%) review and 4th Quarter (43%). There were twenty-three cases in which no dental assessment was completed or the case file lacked documentation of any consideration of and/or efforts to schedule dental appointments. The child’s mental/behavioral health needs in 80% (41/51) of the cases were assessed. Family Engagement: ChildNet continues to do well in ensuring parents are notified of all placement changes and has maintained 100% the last two quarters. ChildNet has achieved 92% of all applicable cases. ChildNet continues to excel in ensuring and maintaining children’s important connections while in out of home care. This standard was achieved in 98% of applicable cases. ChildNet has

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continuously achieved this measure. In addition, for 98% of applicable cases, documentation supports that concerted efforts are being made to ensure visitation with parents and 92% of applicable cases ensured visitation with siblings. Outcomes in the area of engaging mothers and fathers in this review sample increased significantly over the previous reviews. There was clear documentation in most cases of efforts to support parents’ engagement with services through ongoing contact with the parent and at times addressing the barriers that prevented the parent from completing required tasks. ChildNet achieved 86% as to the mother and 92% as to the father on all applicable cases. There is ongoing opportunity for improvement in regard to ensuring parents are encouraged and supported to participate in making decisions about the child’s activities. 80% (40/50) of the cases documented concerted efforts to encourage and support participation in making decisions about child's needs and activities for the mother and 70% (26/37) documented concerted efforts as to the father. Concerted efforts were made to actively involve all case participants in the case planning process in 87% of applicable cases. There has been continuous improvement regarding achievement of this standard each quarter. An area in need of ongoing attention is ensuring informed consent or a court order was obtained for the use of psychotropic medications deemed necessary by a physician. Case file lacked documentation of an appropriate consent or court order. There was a decrease from 3rd Quarter (83%, 5/6) to 4th Quarter (50%, 1/2) on having either an informed consent or court order for prescribed psychotropic medications. Overall, ChildNet achieved 80% (12/15) on this standard. Service Planning and Provisions: During the last three quarters there has been four children who were re-abused and/or re-neglected for both in-home and out-of-home cases; however 100% (4/4) of the children were provided immediate and ameliorative intervention and in 97%(28/29), concerted efforts were made to provide or arrange for appropriate services for the family to protect the child and prevent the child’s entry into out of home care. 96% (70/73) of the children had documentation that service referrals were consistent with the child’s needs and/or assessments relating to safety and 90% (37/41) of the children all immediate and emerging safety concerns were addressed. Concerted efforts were made to identify, locate, and evaluate potential relatives and possible permanent placements for children in 84% of applicable cases. ChildNet has fluctuated each quarter in this measure from achieving 80% to 100% and deceasing to 75% in the last quarter. ChildNet continues to do very well with limiting the number of placements for children in out of home care. In 94% (60/64) of the applicable cases did not experience more than two out-of-home placement settings during the periods under review. There was an eleven percent improvement in compliance with this standard from 3rd Quarter (90%) to 4th Quarter (100%). An area that requires improvement is when a child experiences two or more placements during the review period, 60% of the applicable cases were planned placement changes in effort to achieve the case plan goal. ChildNet is doing well in ensuring the court was informed of placement changes/reasons, a 97% achievement for applicable cases. ChildNet did very well and has maintained a 100% for each quarter on ensuring children, fifteen years of age and older, progress towards successfully transitioning from foster care to

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independence through regular informative staffing. Eighty-five percent (11/13) of the teen-aged children had documentation they were afforded opportunities to participate in normal life skills activities. The frequency of the services worker’s visits with all case participants has improved with each of the quarters. This standard was achieved in 72% (54/75) of cases reviewed. One area to continue to focus on is the quality of visits with fathers, in which we achieved 64% of applicable cases. The quality of the services worker’s visits overall has improved significantly each quarter and ChildNet achieved 91% (67/74). ChildNet has shown slight improvement in ensuring follow-up services are provided to ensure a child’s educational, physical, dental and mental/behavioral needs are met. However, continued improvement is needed as some case files lacked sufficient documentation to determine whether or not assessments and/or services were provided. When educational needs were identified services were engaged in 83% (19/23) of the cases and 79% of applicable cases in which services were initiated, services effectively reduced/resolved the focus child’s education needs. When physical health care needs were identified services were provided to 69% (31/45). When dental health care needs were identified services were provided to 62% (16/26). When needs were identified to address mental/behavioral health issues in forty cases; services were provided in 88% (35 children) and the agency followed up on all treatment plans that were ordered in 94% (33/35) of cases. Promoting Case Progress: ChildNet achieved 94% (50/53) and continues to do very well with placement stability and has achieved 90% (9/10) in children who did not re-entry out-of-home care in less than twelve months following a discharge. ChildNet achieved 100% each quarter in ensuring the case is designed to achieve permanency and safety and stability through appropriate tasks for the case participants. There were current case plans in 76% (57/75) of the cases and 90% (52/58) of those cases permanency goals were appropriate based on the child’s and family’s circumstances. An area in need of attention is having a current case plan. Some case files had documentation of an updated case plan in the file and some were submitted to the courts; however the case files lacked documentation of a court order approving the case plan. This has been a trend over several review periods. Eighty-one percent (34/42) of the case plans specifically addressed visitation and/or other contacts with all case participants. Case file documented evidence of ongoing, meaningful communication with service providers to determine the effectiveness of services in 87% (62/71) of cases. There was ongoing improvement seen in the standard for each quarter. Communication between case management and providers was typically documented via receipt of evaluations, progress reports, and/or certificates of completion. There were also several instances of direct communication between the case management and providers. ChildNet is doing well in regard to maintaining children’s placements within close proximity to parents in order to facilitate frequent visitation. This standard was achieved in 90% of the applicable cases and 100% was achieved for children who were not placed within close

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proximity to parents, it was based on the child’s needs and achieving the case plan goal. Thirty-four percent (13/38) of siblings were not placed together; however in 91% of those cases there was clear evidence separation was necessary to meet the child’s needs. The inquiry to determine if a child was of Native American or Alaskan Native heritage continues to be an area in need of considerable attention. ChildNet achieved 22% in this standard. The completion of the ICWA form has been a continual need and little improvement has been noted during the reviews. Of the cases that had a completed ICWA form, 33% of applicable cases provided timely notification and 67% of applicable cases concerted efforts were made to place the child in out-of-home care in accordance with the Indian Child Welfare Act (ICWA). ChildNet has maintained a 100% each quarter documenting meeting the standard of completing an Interstate Compact for the Placement of Children (ICPC) packet in the required timeframe. In addition ChildNet continues to ensure the information provided in the ICPC packet is sufficient to enable the receiving state to make an appropriate decision regarding placement for the focus child. Forty-five percent of applicable cases included children who were in out of home care for at least 12 of the most recent 22 months; however a TPR petition had not been filed; however 94% of applicable cases had documentation of a compelling reason for not filing a petition. ChildNet has maintained a 100% each quarter documenting appropriate steps taken to identify/recruit an adoptive family that matched the child’s needs and appropriate steps taken to process and approve an adoptive family that matched the child’s needs. ChildNet has provided guidance and assistance in developing an educational and career path based on the child’s needs in 92% on all applicable cases. ChildNet achieved a 95% (71/75), and continues to do well, in Judicial Reviews being held timely and Judicial Review Social Study Reports providing a thorough investigation and social study regarding all pertinent details relating to the child. Supervisory Review and Oversight: Supervisor reviews continue to be an area in need of considerable attention. Supervisor reviews are neither frequent enough nor qualitative enough to adequately address all aspects of the child’s safety, permanency and well-being. In the cases in which supervisor reviews were found, they were lacking in-depth discussions of case issues, identification of barriers in achieving permanency and action plans with specific dates for tasks. Qualitative supervisor reviews and follow through was conducted in 48% (36/75) of cases. Supervision was occurring quarterly in 49% (37/75) of cases; supervisor considered all aspects of the child’s safety, permanency and well-being in 68% (51/75) of cases and reviewers noted in 51% (38/75) of cases the supervisors ensured follow through on guidance and direction provided. Addressing Findings

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Each case was debriefed with the case manager and/or supervisor so each unit is aware of their case findings and where improvements may be warranted. ChildNet is currently in the process of deploying and implementing, a reorganization of the agency’s Client Services Department which would align the units by the child’s permanency goal. This is expected to improve overall performance and improvement is expected in 2010/2011 second quarter. ChildNet has approximately seven (7) Child Advocate Supervisors who completed the Quality Reviewer’s Training and have assisted in 4th Quarter base file reviews. ChildNet has recognized the need for a stable workforce and has created a Lean Six Sigma Project focused on Employee Retention. Once the workforce begins to stabilize, service delivery is expected to improve and should result in improved outcomes for children and families. ChildNet Recommendations

• Case Management to develop a proactive strategy to track the ongoing timely and

qualitative six month family assessment and track the timely completion of ongoing assessments throughout the life of the case and at critical junctures. Family assessments need to be completed utilizing information obtained from case participants, service providers, observations and interaction, as well as, information learned from other sources to provide a complete and accurate assessment of current family functioning as long as the case remains open to services.

• Case Management reviews the process for enhanced oversight of supervisors to ensure all case documentation is reviewed on a regular basis; supervisory recommendations are case specific, address safety, permanency and well being and address the status of action steps from the previous review.

• Case Management to be provided access to the Quality Assurance tool and provide training to all supervisory and front line staff in the basic requirements of each standard in the tool. It is further recommended the development of routine in-service training on the standards.

• Case Management creates a desk reference that incorporates quality examples of work products such as supervisory reviews; initial and ongoing assessments; visit with case participants; case management forms and legal documents (Judicial Reviews/Case Plans) that is used as a guide for supervisors and field staff.

Community Stakeholder Interviews

Below is a summary of the community stakeholder interviews conducted by Regional Quality Assurance staff. Interviews covered the 7 System Factors identified by the Office of Quality Assurance in the “Guidelines for Completing Quality Assurance Reviews.” Interviews were conducted with a minimum of 3 classes of stakeholders for each of the 7 systemic factors. This summary includes systemic trends identified in Broward County (Circuit 17) for the following factors: 1) Statewide Information System, 2) Case Review System, 3) QA System, 4) Staff and Provider Training, 5) Service Array and Resource Development, 6) Agency Responsiveness to Community and 7) Foster and Adoptive Licensing, Recruitment and Retention.

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1) Statewide Information System interviews were conducted with Circuit 17 Administrator, ChildNet CEO, one focus group comprised of Child Protective Investigations and Child Advocates (case managers) and a second group with Child Protective Investigation and Child Advocate Supervisors. The interviews revealed FSFN is utilized differently by the Executive Leadership than it is by the supervisors and front line staff. Executives typically do not access FSFN directly, but utilize their analytical staff to obtained FSFN data. Executives report their use of FSFN is tailored for data utilized to assist them with management decisions and organizational development. In contrast, supervisors stated FSFN reports and tickler systems are an integral part of their daily functions and data obtained drives much of the everyday management of their staff and units. Investigators and Case Managers utilize FSFN as the system of record to update all their day-to-day case related activities. This tiered level of utilization works as a form of checks and balances for maintaining the integrity of the data entered and easily identifies inconsistencies which are reviewed and validated at regular intervals internally by ChildNet’s CQI staff and externally by Regional Quality Assurance staff.

2) Case Review System interviews were conducted with a Circuit Court Judge, Guardian Ad Litem (GAL) Circuit Director and president of the Foster and Adoptive Parent Association (FAPA). They were interviewed regarding how effective ChildNet is in ensuring each child has a timely case plan developed jointly with the child’s parent. These stakeholders stated, generally, initial case plans are developed and filed on time because at the inception of the legal process mediation occurs and case plan tasks are established based on the outcome of the mediation. The FAPA president expressed, from her personal experience as a foster parent, ChildNet has been very effective keeping the parent involved with the case planning process. She acknowledged however this may not be the norm in all cases. The Judge and GAL Circuit Director both stated child welfare service delivery improved significantly, but there is still room for improvement when it comes to engaging parents and age appropriate children in the case planning process. Although ChildNet periodically holds permanency staffing during the life of a case, parents and caregivers do not usually attend. It is not clear whether this is because they are not invited or because they just do not want to attend. All parties interviewed stated communication and coordination of services are effective between ChildNet and professional stakeholders like Office of Attorney General and Guardian Ad Litem; however, communication between ChildNet staff and families remains an area in need of improvement.

3) The Quality Assurance System factor included interviews with ChildNet’s Vice President of Client Services, a Board Member, and the Director of Continuous Quality Improvement (CQI). These interviews revealed ChildNet’s Quality Assurance (QA) system is consistent with the statewide design. In addition, ChildNet elected to review a number of cases above the required twenty-five and write quarterly reports rather than just the state required annual report in order to fulfill their requirement for COA accreditation. During fiscal year 2009-10, the state excused the first quarter reviews for all Community Based Care organizations and reviews were only conducted for the 2nd, 3rd, and 4th quarters. Each quarterly review consisted of twenty-five cases of which seventeen were selected for base reviews by ChildNet’s QA staff. The remaining eight cases were reviewed as part of the Side-by-Side (SBS) Review with ChildNet and Regional QA staff making up the review teams. Subsequent to the Base and SBS file reviews, outcomes were debriefed with the respective Supervisors and Child Advocates. Each quarter two cases were identified for in-depth, case specific interviews. ChildNet QA completed the interviews on the Base review cases and Regional QA completed the interviews on the SBS cases. The in-depth interviews provide further insight into the quality of service delivery and help

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ensure that they are evaluating quality effectively. A major strength identified by stakeholders is the support and buy in to the Quality Assurance process by senior management and board members. At the beginning of the FY senior management and board members review and approve the Quality Plan for the year to assure buy in on all levels. Additionally has provided Lean Six Sigma training and certification to vast cross section of their staff including their CQI staff. With these highly trained staff they are able to systematically identify gaps in performance data from QA reviews, FSFN and Dashboard. QA staff can skillfully drill down to identify root causes and determine counter measures to close the gaps. Deficiencies or gaps in performance often times drive the development of policy and procedures as well as training in areas such as psychotropic medications and Independent Living.

4) Staff and Provider Training interviews were conducted with the ChildNet Director of Training, the Foster and Adoptive Parent Association President, and the protective investigator/case managers’ focus group. ChildNet staff who provide child welfare services are required to attain certification in accordance with DCF requirements. ChildNet has developed an internal data base that tracks training for all their child welfare workers. Trainers and supervisors utilize the program to track the training status of staff. Staff can also sign in to the data base and monitor their own training requirements. In addition to the certification requirements, ChildNet’s child welfare staff is required to complete at least sixteen credit hours of training each year. SkillNet is also used to monitor training requirements. Training courses are developed and implemented as needs are identified through different channels such as Quality Assurance reviews, decisions from ChildNet’s executive staff, and new DCF requirements. Foster parents are required to complete six-weeks of MAPP training for initial licensure and ChildNet requires their subcontracted providers ensure a minimum of 12 credit hours of training for foster parents to meet their re-licensing requirement instead of the eight (8) credit hours required by DCF. Courses towards re-licensure are offered on line for the foster parents’ convenience and child care is provided for those foster parents who prefer to attend the traditional class setting.

5) Service Array and Resource Development interviews were conducted with an Independent Living (IL) youth, Child Protection Team (CPT) Case Coordinator, Kids in Distress (KID) Senior Vice President and the Children Services Council (CSC) Resource and Systems Manager. Each stakeholder interviewed provided consistent statements regarding the service array as it relates to the effectiveness of ChildNet. Most impressive was the IL youth who stated she feels ChildNet has gone above and beyond in providing her services. She stated they found her a suitable placement in Broward County within days of her entering foster care; included her in identifying her case plan goal and tasks; and, made it possible for her to attend the Dependency Summit with Florida Youth Shine in 2009. Other stakeholders, like CSC, help fund family strengthening programs to enhance state mandated requirements; whereas KID contracts directly with ChildNet to provide an array of services including shelter beds, licensed foster homes, daycare, therapy, and post adoptive group support. KID feels ChildNet is effective in meeting the needs of children and families, however when it comes to the delivery of therapeutic services an enormous amount of documentation is required which detracts from meeting client needs and leans towards compliance. CPT, although not directly involved with CN on the service end as they are with BSO child protective investigations, states ChildNet is very effective in delivering services and concurs there are a plethora of services available in Broward County.

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6) Agency Responsiveness to Community interviews included the Circuit 17 Administrator, ChildNet Vice President of Client Services, and a ChildNet Board Member. This systemic factor speaks to how effectively ChildNet engages in on-going consultation with various stakeholders and how input from the community is incorporated into the system of care. Interviews conducted at the executive level were consistent in their perceptions of how effective ChildNet is in engaging and ongoing consultation with other stakeholders in the community. ChildNet has a specialized unit working only with ICWA cases. Staff works closely with a Tribal Representative to meet the specific ICWA requirements. ChildNet is in the process of reorganizing operations to increase the number of service units and child advocates in order to promote expertise and reduce case loads in an effort to improve service delivery to clients. Service Providers, responsible for recruiting and licensing foster homes, are urged to recruit candidates committed to being long term foster parents as well as identify those who continuously do not take children in order to rescind their license if they choose to remain inactive. ChildNet also has a centralized unit specializing in serving children with extraordinary needs including those with a DJJ history. Regarding ChildNet’s Board of Directors, the board consists of prominent residents most of whom represent organizations that mutually serve children and families involved with the dependency system and who share similar concerns for the welfare of clients.

7) Foster and Adoptive Licensing, Recruitment and Retention interviews were completed with the FAPA President, Child Protective Investigation/ Child Advocate Supervisors’ focus group, and the ChildNet Director of Licensing and Contracted Services. ChildNet subcontracts child caring and adoption recruitment to approximately fifteen agencies and each agency determines their own method of recruitment. ChildNet independently hosts adoption recruitment open house the 3rd Thursday of every month and hosts other adoption recruitment events throughout the year. Referrals from these events are disseminated to the subcontracted providers who follow up with the interested candidates. Youths available for adoption are photographed by professional photographers and their photos are displayed in office buildings and shopping malls throughout the county. ChildNet’s Vice President of Network Development attends the FAPA monthly meetings and arranges for guest speakers to address the group on the subject of adoption. ChildNet’s adoption unit is responsible for reviewing home studies to ensure thoroughness and thus expedite DCF’s review and approval of adoptive home studies. All of ChildNet’s licensing staff is certified in child welfare as a result of ChildNet pending COA accreditation process. The Unified Home Study in FSFN was implemented statewide in 2009; however supervisors from the focus group expressed that the home studies take up to two hours and is an efficient or effective use of the staff’s time. The supervisors suggest if a pre-qualifying step were implemented, their staff would not waste valuable time completing an entire home study for every candidate, but only on those who passed the prequalifying process. ChildNet’s case management and BSO’s protective investigation supervisors’ stated they work well together and attribute this partly to their offices being physically located only a few doors away from each other. Supervisors stated they do not experience the same level of collaboration on Out-of-Town Inquiries (OTI) and Interstate Compact for Placement of Children (ICPC) referrals sent to other jurisdictions whereas ChildNet has a unit designated to case manage incoming OTI and ICPC cases and handle the cases with the same standard as they do cases within the local jurisdiction. Supervisors stated this is an area needing improvement because when one of their primary OTI /ICWA cases are selected for a QA review they are penalized in areas where they have limited control.

Annual Quality Improvement Plan (QIP) Progress Findings

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CFSR Item Measurement based on QA standards Outcome Safety 2: Children are Safely Maintained in Their Homes Whenever Possible and Appropriate.

• Item 3: Services to Family to Protect Child(ren) In-home and Prevent Removal or Re-entry into Foster Care. The three case management standards for Item 3 are: services to protect the child, 97% (28/29); service referrals, 96% (70/73) and management of risks, 95% (20/21). The overall performance for all the quality practice standards was 96%.

• Item 4: Risk Assessment and Safety Management. The four case

management standards for Item 4 are: initiation of immediate interventions, 100% (3/3); initial family involvement, 85% (22/26); immediate and emerging safety concerns, 90% (37/41) and safety assessment, 91% (30/33). The overall performance for all the quality practice standards was 92%

Outcome Permanency 1: Children have Permanency and Stability in Their Living Situations.

• Item 7: Permanency Goal for Child. The case management standard for Item 7 is case plan goals, 90% (52/58). The overall performance for the quality practice standard was 90%.

• Item 10: Other Planned Permanent Living Arrangement – The case management

standard for Item 10 is the agency made concerted efforts to ensure the child is adequately prepared to transition into independent living and is living in a permanent arrangement until he/she reaches the age of majority, 100% (1/1). The overall performance for the quality practice standard was 100%.

Outcome Well-Being 1: Families have Enhanced Capacity to Provide for Their Children’s Needs.

• Item 17: Needs and Services of Child, Parents, and Foster Parents. The six case management standards for Item 17 are: ongoing assessments of the child’s needs, 92% (68/74); ongoing assessments of the mother’s needs, 88%, (52/59); engaging the child’s mother, 86%, (51/59); ongoing assessment of the father’s needs, 88% (38/43); engaging the child’s father, 92% (36/39) and ongoing assessment of out-of-home care providers, 98% (56/57). The overall performance for all the quality practice standards was 91%.

• Item 18: Child and Family Involvement in Case Planning. The case

management standard for Item 18 is: case planning process/family involvement, 87% (65/75). The overall performance for all the quality practice standards was 87%.

• Item 19: Caseworker Visits with Child. The two case management standards

for Item 19 are: frequency of service worker’s visits, 81% (61/75) and quality of the service worker’s visits, 92% (69/75). The overall performance for all the quality practice standards was 87%.

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• Item 20: Caseworker Visits with Parent(s). The four case management

standards for Item 20 are: frequency of service worker’s visits with the mother, 53% (29/55); quality of the service worker’s visits with the mother, 74% (37/50); frequency of service worker’s visits with the father, 58% (23/40) and quality of the service worker’s visits with the father, 83% (30/36). The overall performance for all the quality practice standards was 66%.

96%

92%90%

100%

91%

87% 87%

66%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Item 3 Item 4 Item 7 Item 10 Item 17 Item 18 Item 19 Item 20

Item Numbers for Annual Summary of Quality Assurance Review Findings

85%80.5% 80.7% 82.1%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Safety Permanency Well Being Overall PracticeStandards

Annual Overall Performance on Safety, Permanency and Well-Being

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List of Standards and Data Roll-Up

Summary Totals: