chapter 6 pulling it all together casa medical advocacy · chapter 6 pulling it all together –...

CASA: Medical Advocacy Training Program

6-1

Chapter 6 Pulling it All Together – CASA Medical Advocacy

Introduction

As stated at the beginning of this training, the primary goal of CASA Medical

Advocacy is to ensure that the child receives regular well-care, dental care, and

immunizations as well as any other necessary healthcare services while they are

in out-of-home placement. With the support of the CASA Case Supervisor (or

other designated staff), you -- the CASA volunteer -- should use your investigative

and advocacy skills to:

Gather information regarding the child’s health status, immunizations, and the assessments and care provided to the child. This may include not only gathering information but also filling in information gaps.

Help to ensure that any/all specific healthcare needs of the child are being met (including provision of regular well-care, dental care, and immunizations).

Provide the Court with timely, objective, and unbiased information based upon the information gathered; this will allow the Court to make well-informed decisions on the child’s behalf.

Information Gathering and Records Review

The information gathering process may be as simple as reviewing a complete

DYFS office file and requesting and reviewing the Blue Health Care Case

Management (HCCM) Record. Note, the Blue HCCM Record is maintained by the

Child Health Unit but must be requested from the DYFS caseworker. Depending

on the procedures within your individual CASA program, these files may be

available to you through your Case Supervisor, or you may need to submit a

request to DYFS to review (and, if possible, copy) these files.

After you have an initial meeting with your Case Supervisor to collect/review the

file for information, you should begin to schedule information gathering visits.

When scheduling your visits, you should call first to explain the CASA role and the

purpose of the proposed visit – this will promote good will and demonstrate

respect for the other person’s role going into the visit. This also allows the other

person to make the necessary preparations (i.e., obtain clearance, pull files, and

set aside time for the visit). A copy of the Order of Appointment should be

forwarded prior to the visit to ensure cooperation.

It is critical that you review all available medical files in order to get a candid

snapshot of the child’s healthcare history and ensure that any health-related

issues are identified and addressed.


6-2

As you begin gathering information, you should complete the Advocate

Questionnaire for Medical Information, which contains questions regarding the

basic, minimum information needed to initiate any healthcare advocacy. The

information obtained and documented on this Questionnaire can then be used as

the jumping off point in compiling a complete healthcare history for the child.

If the DYFS file and Blue HCCM Record do not contain a complete record (or all of

the healthcare information that you feel is needed), then you can request further

information from a variety of sources. Utilizing the steps outlined in the CASA

Health Information Gathering Guide, you can seek information from the sources

outlined on the page entitled Healthcare Information Sources. Additionally, the

following list, while not all inclusive, is an excellent starting point in trying to

create a healthcare file:

Local DYFS office (may or may not contain complete medical history)

School nurse (may have immunization records, hospital/PCP healthcare records)

Child’s Primary Care Provider (may be complete if the child has been seen regularly)

Biological Parents/Family Members (may or may not possess complete healthcare records)

Foster Parents (may or may not have complete records)

As you begin compiling full medical information, you can keep a running record

of this on the CASA Checklist for Health Information. This Checklist can be used

annually to update the child’s health information and provide a year-to-year

comparison.

Ensuring Appropriate Healthcare

Chapters 2 though 5 of this manual should provide you with a significant amount

of information and a variety of “Points of Advocacy” that can be utilized to help

ensure that the healthcare needs of your assigned child are being met and that

the child is receiving the appropriate healthcare. Again, the primary goal of CASA

Medical Advocacy is to ensure that the child receives both regular well-care as

well as any other necessary healthcare services while they are in placement. It is

NOT your role as a CASA volunteer to diagnose a child or recommend specific

treatments. Rather, as the CASA volunteer, you should be working closely with

the child’s DYFS caseworker to ensure that timely and appropriate healthcare is

being provided and that the child’s medical and mental health needs are being

met.

Depending on your individual child’s medical issues, there may come a time

when non-routine medical interventions are necessary (including but not limited


6-3

to surgery or special testing). DCF policy states that, unless parental rights have

been terminated, any such non-routine medical interventions would require

parental consent. In the event that parents are not available or able to consent,

DYFS would seek Court intervention to allow the DYFS Local Office Manager (or

his/her designee) to provide the needed consents. Additionally, if a youth is 18

or older, it is up to them to provide consent for both routine and non-routine

care. It is important to remember the critical role that you as the CASA volunteer

can play in ensuring that the appropriate consents have been provided for non-

routine medical interventions.

As a CASA volunteer, you are in a unique position to facilitate communication

regarding the consents needed and to ensure that they are provided. There are

many steps to be taken and signatures needed along the way when a child needs

surgery or other non-routine care – you can facilitate communication to ensure

that parents, caregivers, and DYFS are aware of what is needed and that steps

have been taken to ensure that the needed items are in place. In addition, you

are able to be present to provide support to the child and even the caregivers

during any non-routine medical intervention – this can mean so much to a child.

Providing the Court with Timely, Objective Information

As the CASA volunteer, you should provide the Court with timely, objective, and

unbiased information based upon the information gathered. The vehicle for this

information is the CASA Court Report. The CASA Court Report should include

updates on the child’s health, including information on the provision of well-care

as well as information on any specific medical or mental health needs and

whether they are being addressed. If necessary, you should make

recommendations for the provision of assessments or needed services.

However, such recommendations should only be made following unsuccessful

advocacy to DYFS for those assessments and services. In the event that you have

been unable to obtain information, that fact and information about the efforts

made to date, should be included in the Court Report as well. Some Sample

CASA Court Reports are provided as an example of the various pieces of

information and recommendations that might be made.

Points of Advocacy for CASA

CASA volunteers are the front line information gatherers and play a key role in ensuring that the child’s medical file is as up to date and complete as possible. The volunteer should utilize the various manual resources to ensure that they are gathering all available information and documenting the information obtained.

CASA volunteers have a unique relationship with the Court such that, if advocacy efforts with DYFS do not succeed in getting a child’s healthcare


6-4

needs met, the CASA volunteer can make a fact-based recommendation in their Court Report in order to get the child’s healthcare needs met.

Remember, it is NOT the role of the CASA volunteer to diagnose a child or recommend specific treatments. Rather, the volunteer should be working closely with the child’s DYFS caseworker to ensure that timely and appropriate healthcare is being provided and that the child’s medical and mental health needs are being met.

In the event that a child requires non-routine medical interventions, CASA can play a critical role in ensuring that all required forms and consents are in place so that the intervention can proceed without delay. In addition, the CASA volunteer’s presence during any non-routine medical intervention lends a great deal of support to the child, the parents, and the caregivers.

Manual Documents:

Advocate Questionnaire for Medical Information

CASA Health Information Gathering Guide with Healthcare Information Sources

CASA Checklist for Health Information

Sample Court Reports

Note to Case Supervisors:

CASA Manager should always be updated with information regarding the child’s

healthcare. These updates are to be made in the “Health” tab of the Child

Information section of CASA Manager. There are four (4) different screens where

information can be entered:

1. Immunizations/Meds – here, you can list the child’s doctor(s), insurance, medications, and immunizations with dates

2. CHEC Exam – here you can collect all information regarding any CME or CHEC that the child has undergone, including information regarding the findings of those assessments.

3. CHEC Plan of Care – here you can input and track any and all follow-up care that the child requires as a result of the CME/CHEC.

4. Ongoing Care – this area allows you to input and track all ongoing care that the child is receiving, whether it is well-care pursuant to EPSDT guidelines or other healthcare that the child is receiving on an ongoing basis.

CASA programs can also use CASA Manager to track the medical/mental health

services for which the program has advocated by going to the “Services” tab of

the Child Information section of CASA Manager. By keeping these screens

current, CASA can maintain a record of the child’s healthcare needs and whether

those needs are being met.

Advocate Questionnaire for Medical Information

1. Who is the child’s primary healthcare

provider (or the child’s medical home)? (A

pediatrician, nurse practitioner, or family

practice doctor)

Name____________________________

Address: _________________________

_________________________________

Telephone # ______________________

2. When was the last time the child saw

the primary healthcare provider (what for)?

Date _________________

(Please provide name, address and phone if

different from above

Reason:

3. How often does the child go to the

healthcare provider (in a year)?

4. Any medical conditions or diagnosis the

child is being treated for (both past &

present)

Any medications?

Conditions/Diagnosis:

Medications:

5. Has the child had their Comprehensive

Medical Exam (CME) or Comprehensive

Health Evaluation for Children (CHEC)?

When?

CHEC CME No Exam

Date: ______________

Chapter 6 Manual Documents MD6-1

CASA Health Information Gathering Guide Resources and steps to gathering healthcare information

Step 1: Request review of the child’s DYFS case file and blue Health Care Case

Management (HCCM) file and identify the child’s Primary Care Physician (PCP)

or Medical Home and their contact information.

Sources: DYFS caseworker as well as Resource parent and school nurse

Step 2: Discuss the child’s healthcare status with the child’s resource parent. Determine

any concerns, known conditions, healthcare professionals that are involved and

any upcoming or recent appointments.

Step 3: Determine if a Comprehensive Medical Exam (CME) was performed or is

scheduled – obtain copy of the report as well as any Pre-Placement Assessment

(PPA) report.

Sources: See #8 on chart below

Step 4: Review DYFS case file for any medical information, reports, etc. as well as the

child’s blue HCCM file, and check with the caseworker about any known

healthcare issues or appointments.

Step 5: Complete Section I of Health Information Checklist.

Sources: DYFS file/worker, HCCM file, resource parent, other sources listed in chart on

the following page.

Step 6: Request child’s PCP provide the information for Section II on the Health

Information Checklist. If there is a fee involved or other problem, ask the DYFS

Case Worker to request the information from the doctor.

Step 7: Complete Section II of Health Information Checklist – if not completed by the

PCP.

Sources: See chart on the following page.

Step 8: Provide all healthcare information obtained to the CASA Case Supervisor.


Healthcare Information Sources

Information Needed Sources to Obtain Information Additional Comments

1. Immunizations School Nurse

Child’s primary

doctor/Pediatrician

Foster/Resource parent(s)

Focus Report**

NJIIS Report**

DYFS Case File

DYFS Case Worker

** These reports can only be

produced by the division, when

requested by CASA or its Advocates

they must provide a copy. Please

have your Court Appointment Order

with you to show to the different

agencies if needed.

2. Specialty Health Care (ex.

Neurology, Orthopedic,

Gastroenterology, etc.)

Primary Care Doctors/

Pediatrician

Previous Primary Care

Doctors/Pediatrician

Please have your Court Appointment

Order with you to show to the

different agencies if needed.

3. Physical Health Care (ex.

Neurology, Orthopedic,

Gastroenterology, etc.)

Primary Care Doctors/

Pediatrician

Previous Primary Care

Doctors/Pediatrician

This information may also be found

in the DYFS Case File

4. Dental Care Child’s Dentist


This information may also be found

in the DYFS Case File

5. Mental Health Services Child’s primary

doctor/Pediatrician


DYFS Case File

DYFS Case Worker

The child’s known mental

health provider

6. Medications/Special

medical Equipment School nurse

Child’s primary

doctor/Pediatrician

Foster/Resource parent

Specialist MD

Focus Report**

Examples of special equip.:

nebulizer, wheelchair, hearing aid,

etc.

7. Chronic Health Conditions Child’s primary

doctor/Pediatrician


DYFS Case File

DYFS Case Worker

School Nurse

Examples of special equip.:

nebulizer, wheelchair, hearing aid,

etc.

8. CHEC Exam Report

CHEC Preliminary Report

or Comprehensive Medical

Exam (CME) report

DYFS Case File

Foster/Resource Parent(s)

Pediatrician/Family Dr or

CME provider

Due to a shortage of CHEC centers

and Dr.’s, in lieu of a CHEC exam,

children may receive a CME or well

child exam by their PCP. Request

copies of both the preliminary and

final reports for these exams.

Notes:

1. When requesting information or visiting outside agencies, please set up appointments. This includes visits

with the Division (DYFS).

2. Always provide a copy of your Court appointment order.


CASA Checklist for Health Information

Name of Child: ___________________________________________ DOB: ________________

SECTION I - General healthcare information and providers

A. Healthcare Providers

Type of Provider Name Address/Phone Specialty (if applicable)

Primary Care Physician (PCP)

Mental Health

Dentist

Specialist

Specialist

Case Management Services/HMO HMO Name: _________________________________________ Telephone #: __________________________ Case Manager Name: ____________________________________________

B. Current Health Status Known Problems/Conditions Medications Special Medical Equipment

Any other concerns: ____________________________________________________ ___________________________________________________________________

C. Routine Care/Physical Exams Type of Care Date MD Name Address/Phone (if not previously provided)

Last MD visit

Last Dental Visit

Specialty referrals in last year

CME or CHEC scheduled or completed


SECTION II - Detailed Medical Information , Exams, Screenings

Information to be provided by Physician/Healthcare provider

A. Physical Exam Date of last exam: _____________ Height: _________Weight: ________BP: ________Pulse: _______ LMP: _________ Allergies: ___________________

B. Screenings date of appointment or completion, note results and concerns

Hearing Screen

Vision Screen

Tuberculosis (TB/PPD

CBC or Hemglobin Screen

Urinalysis

Sickle Cell Screen

Hepatitis

Lead Screen

C. Health Maintenance Immunizations - *** Copy of immunization records needed

Type Date Type Date Type Date Type Date

Td Flu Pneumovax Hep. B Hep. C Hep. A Varicella MMR

HIB HPV DtaP IPV(polio) Menigoccal Pap:_______________________ HIV:_______________________

D. Medications (name and dosage)

________________________________________________________________________ ________________________________________________________________________

________________________________________________________________________

E. Referrals (List any specialist referrals )

Date Name/Type of Specialist

Address/Phone Reason


COURT APPOINTED SPECIAL ADVOCATE REPORT TO JUDGE VERNA LEATH

Hearing Date: August 2, 2011

CASE NAME: Berry

DOCKET NUMBER: FN-07-010-08

DATE CASA ASSIGNED: March 17, 2010 REPORT WRITTEN: July 28, 2011

CHILD(REN) INFORMATION: Child’s Name DOB & Age DOP # of Prior Placements Arnie

05/30/99; 12 years old 02/11/08

Bernie

04/15/02; 9 years old 02/11/08

Isiah 09/1/05; 5 years old 11/2008 SOURCES: Name Relation to Child(ren) Contact Date Contact Type Arnie Self Various In-person Bernie Self Various In- person Isiah Self Various In-person

Sarah J. Clinical Case Mgr. CAFS Various Telephone Mr. & Mrs. D Resource parents to Arnie

and Isiah 05/23/2011

In-person &

Mr. & Mrs. D Resource parents to Arnie and Isiah

07/15/2011 Telephone

Mary P. Kindergarten teacher, Isiah Various In-person Gerri F. Reading Specialist, Isiah 06/13/2011 In-person Ms.O. DYFS Case manager 07/19/2011 In-person HEARING TYPE: Compliance Review REASONS FOR PLACEMENT: Terri, Arnie, Bernie, and Isiah Berry were taken into custody on February 11, 2008 after their maternal grandmother, Pansy Berry, called the Division on January 28, 2008. At the time, their grandmother reported that natural mother Sissy Berry was incarcerated after a verbal altercation with a store clerk that ended with Ms. Berry kicking the glass out of the store window. Prior to this phone call, there had been several referrals to the Division, alleging neglect. It was further reported that Sissy Berry frequently left the children in the care of Ms. Pansy Berry or in the care of the eldest child Terri, who was 11 at the time. Placement with natural father, Anthony Lange, was not possible, as he was incarcerated at the time. PLACEMENT HISTORY: After being taken into custody by the Division, Arnie and Bernie had two previous resource home placements before being placed with Ms. S and Mr. G in Irvington, NJ on April 2, 2009. Previously, one of their placements had been with family friend Ms. R in Jersey City, NJ. The boys were removed from her custody and placed with Ms. S as a result of an argument between NM and Ms. R.


On May 19, 2010, Bernie Berry was separated from his brother, Arnie, and placed with Ms. R. He was removed from his previous placement at the request of his former foster parents Ms. S and Mr. G, who reported they were no longer able to manage his behavioral concerns. Arnie Berry was in placement with Mr. G until 04/04/2011. (Ms. S. and Mr. G are currently separated.) Arnie was removed from placement at Mr. G’s request; Mr. G said he was no longer able to care for Arnie. Isiah Berry was in placement with Ms. R. He was removed at the Division’s discretion on 04/04/2011. Both Arnie and Isiah Berry were placed in the care of Ms. G. in Montclair, NJ on 04/04/2011. Due to a conflict between Ms. G. and her adoption service (Babyland), she was unable to continue to serve as a resource parent. Bernie was placed at the Path One Group Home, a therapeutic group home, in Paramus, New Jersey on 07/26/2010. Both Arnie and Isiah Berry have been placed in the care of Mr. and Ms. D. in Dumont, NJ since 05/09/2011. SAFETY RISK FACTORS: At this time, there are no known safety risk factors to Arnie, Bernie or Isiah Berry. EDUCATIONAL HISTORY: Arnie Berry - Arnie has attended Mount Vernon Avenue School in Irvington, NJ, since his placement with Ms. S and Mr. G from 04/02/2009 to the present. His resource parent, Ms. D., reports that he will be enrolled in Selzer School in Dumont in the fall. Bernie Berry - Bernie has been enrolled in Alexander D. Sullivan School (P.S. 30) in Jersey City, Mount Vernon Avenue School in Irvington, and Midland Elementary School in Paramus since coming into the Division’s care. Bernie currently has an IEP and is classified as Emotionally Disturbed. He began attending Windsor Learning Center in Pompton Lakes on 03/18/2011. He continues to attend the school’s summer session, working on math, reading, and other activities. Isiah Berry - Isiah has been enrolled at Alexander D. Sullivan School (P.S. 30) in Jersey City since 09/2010. He is having academic and behavioral difficulty in school. Ishmiel has taken part in a special reading program through his school but shows little improvement. CASA observed Isiah in his mainstream classroom and during his small-group sessions with a reading specialist. While Isiah is behind his peers academically, he seems capable, with specialized individual instruction, of catching up to grade level. However, his attention-seeking behaviors distract him from learning both in the classroom and in his small group. Both his teacher and reading specialist are concerned about his ability to perform at grade level next year in the first grade. He will also be enrolled at Selzer School in the fall. PSYCHOLOGICAL HISTORY: Arnie Berry - In order to address some recent behavioral issues, Arnie Berry receives weekly therapy through Children’s Aid and Family Services.


Bernie Berry - At his current group home, Bernie receives both individualized and group therapy on a weekly basis. He receives both small group and in-class therapy at Windsor Learning Center (30 minutes each, once a week). Isiah Berry - Isiah behaves when at home with his foster parents, but in the classroom and some other social settings, he shows attention-seeking behaviors that need to be addressed. He receives weekly therapy through Children’s Aid and Family Services.

SOCIAL: Arnie Berry- Arnie is generally well-behaved. His foster parents report that he is making new friends in his new neighborhood, and that he is attending a recreational day camp this summer from 9:00am-3:00pm Mondays-Thursdays. He plays basketball, swims, and is generally doing well. His foster parents report that he occasionally shows a disrespectful attitude, though not one that is unusual in someone his age. Bernie Berry - Bernie is responding well to his new school. The school’s points-based behavioral modification system combined with his new medication and continued therapy at his group home have had a noticeable effect and CASA has observed remarkable improvement in his behavior. He is friendly, courteous, appropriate with other children and adults, responsible, and honest. Isiah Berry - Isiah Berry has some difficulty behaving in school and other social settings, but his foster parents report that he behaves well at home. MEDICAL: Arnie Berry - No known medical issues. Bernie Berry - Bernie’s medication is as follows: Abilify, 2.5 mg, administered once daily in the evening, to assist with concentration and focus in school. Cogentin, 0.5 mg, administered once daily in the evening, to counter known potential side effects from Abilify. Bernie showed Neutropenia during a routine blood test, so he was removed from medication on May 25th until a hematologist was consulted. The group home’s nurse confirmed with the doctor that Bernie could safely remain on his medication and it was resumed on June 16, 2011. He went back for a re-check at the beginning of July; results are forthcoming. Isiah Berry - Isiah’s foster parents think he might be a candidate for medication to address his behavioral issues. To this end, they have begun the process of a psychological evaluation, and he has been seen for lab work, as well as an EKG and EEG. The results of his EEG will be interpreted on July 26th. Once completed, the evaluation will determine the need for medication. Isiah has dentist appointments in early August to address several dental issues, including a root canal and cavities.


WISHES OF THE CHILD: Bernie Berry - Bernie is happy but asked when he will be able to return home. Arnie and Isiah Berry - CASA was unable to speak directly with Arnie and Isiah, as they are on vacation with their foster family through the end of July, though during an earlier visit at the end of May, Arnie expressed his desire to return to his home and his frustration with being moved around to so many different placements. COMPLIANCE WITH THE CASE PLAN: Arnie, Bernie, and Isiah Berry are taken weekly to see their father, Anthony Lange, who was released from prison in April, at a separate time from their normal sibling visits. According to DYFS worker, Ms.O, Mr. Lange has missed three of six visits. Sometimes this was due to transportation issues, but he declined the DYFS case worker’s offers to provide him with transportation on those occasions. On one occasion, he said that he had promised the children he would cook for them for their next visit, and did not want to attend the visit because he was unable to. CONCLUSIONS/RECOMMENDATIONS: CASA recommends that Isiah be evaluated by the Child Study Team. Both his teacher and his reading specialist have expressed concerns that Isiah will be lost in a mainstream classroom next year. After classroom observation, CASA has similar concerns and is especially troubled that he might fall even further behind, both academically and socially, if his issues are not addressed as soon as possible.

Respectfully submitted,

Jane Doe CASA Volunteer

Martha Murray Senior Case Supervisor


of 6

COURT APPOINTED SPECIAL ADVOCATE REPORT TO JUDGE LEATH Hearing Date: 4/12/2011 CASE NAME: Cummings, Cynthia DOCKET NUMBER: FN-07-20-11 DATE CASE ASSIGNED: 11/29/2010 REPORT WRITTEN: 4/06/2011 CHILD(REN) INFORMATION: Child's Name DOB & Age DOP # Placements: Tommy 9/9/92; 18 years 8/10/10 1 Valerie 9/7/97; 13 years 8/10/10 1 Susan 6/20/01; 9 years 8/10/10 1 SOURCES Name Relation to Child(ren) Contact Date Contact Type Ms. M.T. Foster mother 3/29/11

4/4/11 4/6/11

v-mail v-mail v-mail

Ms. Laurie J. DYFS Caseworker 3/22/11 4/6/11

Phone Email X2

Ms. M. LTDC, 13th Ave. Elem. 4/5/11 4/6/11

v-mail Email X3

Ms. Cynthia Cummings Biological mother 3/9/11 v-mail Ms. E. CST Case Mgr., JFK School 3/21/11

4/5/11 4/6/11

Phone v-mail Email

Ms. M. CST Case Mgr., 14th Ave. Elem. 4/5/11 4/6/11

v-mail Email X2

HEARING TYPE: Compliance Review REASONS FOR PLACEMENT: As indicated in DYFS reports, Tommy, Valerie and Susan were placed in emergency resource home care following an incident where the children’s mother, Cynthia Cummings, and the children had been transported to the hospital (UMDNJ), after a reported altercation between Ms Cummings and her paramour. The children were unharmed but due to the nature of the incident it was deemed the situation posed eminent danger/risk to the children’s safety. It was also reported that Ms. Cummings was intoxicated at the time of the incident. Upon coming into care, Tommy, Valerie and Susan were initially placed with Ms. Y. S. in Irvington but were removed on 10/27/10 and placed in foster care with Ms. M.t. and her family in Maplewood where they currently reside. CURRENT PLACEMENT: All three children are currently a DYFS approved resource parent Ms. M. T., along with her long-term paramour, her mother, her sister and her sister’s very young son. SAFETY RISK FACTORS:


of 6

As of this report, CASA has no safety concerns regarding the current placement; however it has been reported by two of the schools that the FM is active in the educational programs the children are in. Although CASA has been appointed Limited Guardian for Education, two of the schools have specifically expressed that they would appreciate consistent contact from the FM regarding the day-to-day situations that may arise and follow up that may be needed since she is the primary caregiver. EDUCATION: Tommy: Tommy continues to attend the JFK School and his progress is still minimal as previously

reported. Tommy is expected to remain in this school until he ages out at 21. Tommy’s IEP documentation was completed and as per phone conversation with Ms. Murphy (CST Case Manager) a copy was to be forwarded to CASA. As of this report it has not yet been received. Copies will be provided to involved parties upon receipt. Valerie: Valerie C is in the 8th grade and is still currently attending the 13th Avenue School in Newark and is classified as being mildly cognitively impaired and has been placed in a Multiply Disabled (MD) program. Valerie is in a self-contained special education classroom and is scheduled for an updated IEP in April 2011. At IEP review, the issue regarding having Valerie transferred to the JFK School as well as an ESY Program (Extended School Year) will be addressed. CASA is waiting for confirmation as to when the meeting will be held and will notify all involved parties once confirmed. Susan: Susan is in the 4th grade and continues to participate in special education programming at the 14th Avenue School in Newark. Educational records indicate that Susan is mildly cognitively impaired and classified as multiply disabled (MD). She is currently placed into a self-contained classroom of 7 children. Susan is scheduled for an IEP review in April 2011. At IEP review, the issue regarding having Valerie transferred to the JFK School as well as an ESY Program (Extended School Year) will be addressed. CASA is waiting for confirmation as to when the meeting will be held and will notify all involved parties once confirmed PSYCHOLOGICAL: As referenced previously in the 3/1/2011 CASA Court Report: All three children have undergone their neuropsychological evaluations by Jonathan H. , PsyD. and have been found to have various levels of Mental Retardation (the full report on Susan C remains pending). Unfortunately, this coupled with the MIC/MD concluding evaluations of their respective schools, suggest very little self-awareness of their own individual medical condition. Of the full evaluations received, the individual formulations and impressions are summarized as follows: Tommy: Has a neuro-developmental syndrome marked by mild impairment of verbal and nonverbal intellectual functioning, working memory in the range of moderate mental retardation, and receptive language comprehension in the range of moderate to severe mental retardation. DSM-IV-TR diagnoses include: Axis-I Clinical Disorders: Mixed Receptive-Expressive Language Disorder /receptive markedly worse than expressive; Axis-II Personality Disorders/MR: Mild Mental Retardation; Axis-III Medical Conditions: evidence of a mild to moderate neuro-developmental encephalopathy of unclear origin; Axis IV: Psycho-social Problems: lack of primary support group, educational and occupational impairments; Axis V Global Assessment of Functioning: 31/100. Recommendations included consultation/referral to NJ DDD; referral to NJ DVRS for any services recommended by the DDD; to continue as MD with services; ongoing interventional speech and language therapy to help with receptive language; referral


of 6

to work support through the Association of Retarded Citizens (ARC); and life long residential support for mild to moderate mental retardation (this is borderline, he may qualify as having moderate mental retardation – his communications handicap is the limiting factor). Valerie: Has a diagnosis of Moderate to Mild Retardation with a Verbal Comprehension Index of 50, a Perceptual Reasoning Index of 51 and a Full-Scale IQ of 46. She clearly has adaptive behavior deficits (communications and functional academics) and a significant communication disorder with both receptive and expressive deficits. Evaluator found her to be impulsive with very poor response inhibition and her DSM-IV-TR diagnostic impressions include: Axis-I Clinical Disorders: ADHD (combined type) and Mixed Receptive-Expressive Language Disorder; Axis-II Personality Disorders/MR: Mild to Moderate Mental Retardation; Axis-III Medical Conditions: None; Axis IV: Psycho-social Problems: foster placement, exposure to violence; Axis V Global Assessment of Functioning: 35/100. Recommendations include consultation/referral to NJ DDD; to continue as MD with services; ongoing interventional speech and language therapy to build comprehension of daily life; to receive multimodal information presentations; close teacher to child learning; break down of information/directions flow; and, as she ages out, she’ll need NJ DVRS services and may require life-long residential support

Susan: Results of evaluation have not yet been received by CASA. Upon receipt they will be reviewed by the CASA Volunteer, Case Supervisor and CASA Nurse and recommendations made accordingly. SOCIAL: Other than at school, Valerie & Susan continue to have very few social opportunities and/or experiences. Tommy continues to work at Shop Rite, two days a week and after school one day each week through his school’s vocational training component and still verbalizes he enjoys his work. CASA has requested that the school make the appropriate referrals to DVR for Tommy so he can be afforded an appropriate level of vocational training and experience, specifically during the summer months while not in school. Since the 3/1/2011 hearing, CASA and DYFS have reached out to community providers (Community Access Unlimited, ARC of Essex County) and have tried to find social programs and activities that are developmentally appropriate for each. Unfortunately, due to contract and budgeting constraints, programs that provide services for young adults and children with developmental disabilities are unable to provide such services and activities unless the children are referred through DDD. It has been reported that DYFS has initiated the process to have the children evaluated for DDD services. Due to the length of time involved with opening a DDD case, it would be beneficial for a mentor to be put in place that has experience working with young adults and children with the developmental needs Tommy, Susan and Valerie have. The mentor could be able to take them out, help them try new things in their communities and find activities that each enjoys, thus expanding their social skills and increasing their self esteem. Activities recommended include the library, a local community center, the park etc. Susan & Valerie would benefit from a summer day-camp to enhance their social skills and provide them structure while out of school. At the upcoming IEP reviews, CASA will ask the CST Case Managers to recommend any programs they may be aware of or work with through the school. Information will be forwarded to DYFS once received.


of 6

MEDICAL: All three children had CHEC evaluations completed in 2010. Copies were provided to the CASA nurse for review. All three children were reported to be in fairly good physical health other than their weight and recommendations for follow up regarding vision, hearing and dental needs. Tommy and Susan were listed as significantly obese and Valerie was significantly underweight for her height.

TB screenings were administered on 9/9/2010 and follow up for results was required 2-3 days later.

CHEC evaluation for Tommy indicates that he failed vision and hearing screenings and was referred for follow up.

CHEC evaluation for Susan indicates that she failed vision screening and was referred for follow up.

Dental evaluations dated 10/9/2010 indicate a need for dental follow up of all three children; Tommy & Valerie both needing root canals and Susan needing cavities filled.

As of this report, CASA has not received documentation confirming follow up for above-mentioned medical concerns. At minimum, in addition to the recommended follow up, Tommy, Valerie and Susan are due for 6 month routine dental check-ups in April 2011. As previously reported, Tommy C had a seizure 2/22/2011 and has been prescribed Levetiracetam (Keppra) at 500 mg (2x per day). As of this report, CASA has not been made aware of any additional incidents or seizure activity and it has been reported Tommy still takes this medication without issue. WISHES OF THE CHILDREN: Tommy, Valerie & Susan all expressed wanted to live with their mom. COMPLIANCE WITH THE CASE PLAN: As of this report, reunification still appears to be the appropriate plan; however CASA has concerns over Ms. Cummings’s ability to provide the necessary care for her children regarding their disabilities without the appropriate services being in place. In addition to completing in-patient treatment and finding suitable housing, Ms. Cummings will need assistance to handle the various independent living skills of her children. Although Tommy is 18, Valerie 13 and Susan 9, they all have developmental disabilities that require supervision and assistance even with the basic life skills. Due to the family history, minimal if any training has been done in the home regarding these skills. Considering the NM own limitations, the children will require support services both in and out of the home to ensure they are able perform such tasks and in the case of Tommy, to ensure him a stable independent (to the best of his ability) lifestyle. Additionally, knowing the NM history of substance abuse, domestic violence and non-compliance with services in the past, CASA would like to ensure that Tommy, Valerie and Susan have services that will make them eligible for supervised supported housing opportunities should their NM not be able to care for them into adulthood. Although DYFS can provide placement at this current time, as they age out of DYFS, services such as these are provided through agencies that most often require a referral from DDD for eligibility.


of 6

As a result, CASA believes that is is essential that the DDD intake process be completed and the children have open cases with DDD prior to their being placed back in their mother’s direct care to ensure that all possible services are afforded to the family. Additionally, CASA is requesting follow up from the Division to address the name change regarding Tommy. As addressed in the 3/1/2011 CASA Court Report, Tommy’s birth certificate (issued on 10/1/2010), as well as his Social Security Card states that his last name is Spellman, yet all his educational, therapeutic and medical records reflect his last name being Cummings. There is no record of a father’s name on the birth certificate. CASA is concerned that if this is not clarified ASAP, it could quite possibly be an issue regarding referrals for services, entitlements and public assistance. CONCLUSIONS AND RECOMMENDATIONS: CASA recommends that Susan and Valerie be transferred to JFK School for the 2011-12 school year.

CASA is requesting documentation from the Division regarding Tommy’s name change.

CASA is requesting summer day camp be secured for Susan and Valerie

CASA is requesting copies of documentation confirming follow up regarding dental issues for Valerie,

Tommy and Susan.

CASA is requesting copies of documentation confirming follow up regarding Tommy’s vision and hearing referrals

CASA is requesting copies of documentation confirming follow up regarding Susan’s vision referral.

CASA is requesting documentation confirming 9/9/2010 TB screening results.

CASA is requesting copies of documentation for medical follow up regarding Tommy’s seizures.

CASA is requesting a mentor to help engage Tommy, Valerie & Susan in community activities.

CASA requests that the Division continue to follow up on the process to open a DDD file for Tommy,

Valerie & Susan.

CASA requests that the Division continue to encourage NM Ms. Cummings to consider being assessed for DDD services.

CASA is requesting documentation confirming Tommy’s last name and requests that the Division to

make all appropriate changes to current documentation to reflect the appropriate name.

Once DDD case is established for Tommy, Valerie & Susan:


of 6

CASA recommends referring Valerie, Susan and Tommy to the ARC or a similar community provider that specifically works with similar populations for recreation and social activities.

CASA recommends that Tommy be referred to the ARC or a similar community provider that can

provide Independent Living Skills and prepare him for a supported living situation as he transitions to adulthood.

Respectfully submitted,

Rory Thompson CASA Volunteer

Deborah Mitchell CASA Case Supervisor


COURT APPOINTED SPECIAL ADVOCATE REPORT TO JUDGE LEATH Hearing Date: 5/26/11

CASE NAME: Murphy DOCKET NUMBER: FN-07-000-10

DATE CASA ASSIGNED: 4/28/10 REPORT WRITTEN: 5/24/11

CHILD(REN) INFORMATION:

Child’s Name

Theresa Murphy DOB & Age

8/5/99; 12 yrs.old DOP

9/4/09 # of Prior Placements

0

SOURCES:

Name Relation to Child(ren) Contact Date Type of Contact

Ms. W. DYFS Case Manager Several In-person

Mr. H. Rutgers University, Clinical Coordinator Several In-person

HEARING TYPE: Compliance Review

REASONS FOR PLACEMENT: The Murphy family became known to the Division in 1990. On

9/4/09 the Division determined that the natural mother, Loretta Murphy, placed her minor children at

risk when she allowed her paramour, a convicted sex offender to reside in her home.

PLACEMENT HISTORY: Theresa Murphy was successfully placed in the physical custody of her

biological mother in September 2010. DYFS retains legal custody of the child.

CASE UPDATE:

CASA attended a Child Study Team meeting on 3/3/11 along with Loretta Murphy. Also in attendance

was, Ms. Woody, Theresa’s teacher, Ms. Johnson, Social Worker, and Ms. Redding, Speech Therapist.

As previously stated by the Child Study team, and addressed in Theresa’s IEP, Theresa’s present level

of functioning is at a 2nd

grade level. This pertains to reading, math and writing skills. She is in a self

contained classroom, for learning & language disability. There are presently no behavioral concerns for

Theresa. Therefore, the team feels that counseling can be discontinued. Theresa receives speech therapy

once a week for 30 minutes, usually on Tuesday. This will continue throughout the school year. The

team expressed that Theresa would benefit from a tutor, which incorporates a creative approach to

learning. Additionally, Theresa enjoys art, and would benefit by being encouraged to read books at

home on the 3rd grade level. Theresa continues to appear to "shut down" when presented with

challenging course work.

CASA attended a FTM (Family Team Meeting) on April 29th.

In attendance was the DYFS caseworker

and BM, Loretta Murphy. The result of the meeting was that Theresa is receiving adequate and

appropriate care, while placed in the custody of her biological mother. CASA forwarded a letter to the

DYFS caseworker, Ms. Wallace, detailing the information for the Rutgers Psychological Clinic on

December 15th

2010. This information was previously provided by the Law Guardian, The

neuropsychological evaluation develops a clear picture of who the person is, how they are functioning

and what is interfering with their ability to function more effectively. This evaluation relies on multiple

sources of information to produce a comprehensive assessment of the child. The evaluation encompasses


cognitive abilities, brain-behavior relationships, social skills and personality functioning. The result is a

clear diagnosis for the academic, psychological and neurological concerns that may be present and a

basis for interventions in the individualized education plans.

Ms. Murphy was previously in contact with the UMDNJ Department of Psychiatry, to inquire about the

evaluation for Theresa. As per the Division, a letter was submitted to Dr. Tanner of UMDNJ, on behalf

of Ms. Murphy to explain the requested evaluation. A copy of the letter was requested by Ms. Murphy;

however, a copy could not be produced. Ms. Murphy had spoken with the intake department at

UMDNJ, regarding the evaluation and was advised that she would be contacted. In addition, although

previously requested, tutoring has not been established for the child. The explanation provided is that

the Division has only one service provider, Sylvan, that offers tutoring, and is not accessible to Theresa.

CASA continues to have concern about this especially since this service was recommended by the Child

Study Team and Theresa needs this continued intervention in order to proceed successfully in her

education.

CASA confirmed that the Division would be arranging transportation for Theresa to Rutgers University

as well as the expense for the evaluation CASA contacted the Clinical Coordinator at Rutgers, to

confirm the process to initiate the evaluation. As per Mr. H., Clinical Coordinator at Rutgers, he

received a phone call in February from both the Division and Ms. Murphy; however he stated that he

never received a follow up phone call. As per his directive, Rutgers only required a brief telephone

interview to gather additional family information to facilitate the process of having a Clinician assigned.

Ms. Murphy immediately followed up with this process once the requirements were explained by

CASA.

On 5/3/11, CASA received a message from Mr. H. that he had spoken with Ms. Murphy that day and

conducted the intake interview to get the testing started. Mr. H. estimated that there will be three visits

of roughly 1.5 hours, with some room for error. The Division was then contacted by CASA, and

informed about the specifics for the check payment. CASA also spoke with the DYFS Casework

Supervisor, Mr. H. who confirmed that the Division will provide the transportation and payment once

the Clinician was in contact with the Caseworker.

On 5/12/11, CASA followed up with Mr. H. at Rutgers. He advised that he had spoken with Ms.

Wallace of the Division, and obtained her contact information for the Clinician to contact her in order to

coordinate the visits. He mentioned that the Clinician should be in touch with her in the next few

business days.

On 5/17/2011, CASA was in contact with the Division to determine whether contact had been

established with the Clinician from Rutgers. As per the caseworker, she had not been contacted to date

by the Clinician. CASA then contacted Mr. H. from Rutgers, and provided additional phone numbers

for the DYFS Supervisor and Casework Supervisor, in the event that they were not able to contact the

Caseworker. Mr. H. assured CASA that the Clinician should be in contact within a few days.

Incidentally, Ms. Murphy received a follow up call from UMDNJ stating that an appointment is

scheduled for an evaluation for Theresa on June 28, 2011 provided that a referral is submitted by the

primary care physician, Dr. Tanuous. This is an unacceptable timeframe especially since the initial

request was submitted to UMDNJ in March.

On 5/20/11, CASA contacted Ms. Murphy, to determine whether she has been advised of the initial

evaluation date for Theresa, and she informed CASA that she had not heard form the Division or the


Clinician at Rutgers. CASA then advised Ms. Murphy to contact Rutgers in an attempt to secure

information.

On 5/23/2011, Ms. Murphy advised CASA that she had spoken with Mr. H. at Rutgers, and the only

delay was the arrangement of transportation from the Division. As per the DYFS caseworker, the

transportation aid was not available on 5/25/11, therefore the plan was to obtain additional dates from

the assigned Clinician. As per the DYFS worker, the initial evaluation date has been scheduled for

5/31/11. CASA requests confirmation that this date is confirmed as well as the two subsequent visits.

HEALTH:

Theresa had her annual physical in March and has received a second inoculation for the HPV vaccine.

CONCLUSIONS/RECOMMENDATIONS:

CASA recommends that tutoring be established for Theresa immediately. This service is essential for

Theresa’s educational success. She requires a summer program with an educational component. CASA

also recommends that continued monitoring remain in place until the neuro-psychological is complete

and the diagnosis is addressed by the appropriate parties.

Respectfully,

Mercy Lawson

CASA Volunteer

Sally Rogers

CASA Case Supervisor
