Missouri Department of Social Services Children’s Division

1. Missouri Department of Social Services Children’s Division Critical Events Process and Tools

2. Fatality/Critical Event Reporting and Review Protocol The Agency’s Response to Critical Events. • Reporting • Reviewing • Documenting

3. What Are Critical Events?

4. What Other Events require a Critical Event Response?

5. What is a Critical Event Report (CS-23)? The CS-23 provides staff a method for collecting accurate, consistent information quickly in order to notify CD Administration of critical events orother situations that require a critical event response.

6. Critical Event Categories • Critical events are classified by category, which determines the Division’s response. • Categories include: • Category A • Category B • Category C • Category D • Category E

7. Category A Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N with relevant CD involvement

8. Category B Fatality, near fatality, suicide or serious injury • Resulting from alleged CA/N or non-CA/N involving a child with an open FCS case, IIS case or pending hotline.

9. Category C Fatality, near fatality, suicide or serious injury • Resulting from alleged CA/N or non-CA/N and involves foster child.

10. Category D Fatality, near fatality, suicide or serious injury • Resulting from alleged CA/N with no relevant CD involvement.

11. Category E - OTHER… Other events considered serious which meet one of the following: • Media attention - has occurred or is likely to occur • Child in foster care - involving sexual abuse, exploitation or assault • Human trafficking - Reported allegations.

12. Definitions for “Critical Events” Category A, B, C, and D

13. Serious Physical Injury An injury which creates a substantial risk of death or causes serious permanent disfigurement or protracted loss or impairment of the function of any bodily member or organ. [See (42 USCS § 247d-6d (10)]

14. Relevant History The term “relevant history” referenced in this policy refers to prior CA/N or prior open cases which involve similar incidents or allegations of CA/N; or imply a general history of abusive or neglectful behavior related to the current event.

15. Near Fatality “An act that, as certified by a physician, places the child in serious or critical condition." For example: If hospital records reflect the child's condition is seriousor critical, this would be considered a near fatality. [See (Child Abuse Prevention and Treatment Act (CAPTA), as amended (42 U.S.C. 5101 et seq.) - sections 106(b)(2)(B)(x) and (b)(4(A)]

16. Definitions for “Other” Events Category E

17. Media Attention Refers to a critical event that has been or is likely to be covered or referred to by news media, which may include print media (newspapers, magazines), broadcast news (radio, television), or the Internet (online newspapers, news blogs, etc.).

18. The term " sexual abuse " includes: • the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or • the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children. • [See Child Abuse Prevention and Treatment Act (CAPTA), Section 111. [42 U.S.C. 5106g]

19. Sexual Assault Includes the following: • The acts of rape, forcible rape, statutory rape (1st and 2nd degree), sexual assault, sodomy, forcible sodomy, statutory sodomy (1st and 2nd degree), child molestation (1st and 2nd degree), deviate sexual assault, sexual misconduct and sexual abuse, or attempts to commit any of the aforesaid; and • The act of enticement of a child or any attempt to commit such act. (See Chapter 566 RSMo. Sexual Offenses)

20. Sexual Assault (continued) Includes incest, the act of abuse of a child involving sexual contact, and the act of use of a child in a sexual performance. (See Chapter 568 RSMo. Crimes against Persons)

21. Human Trafficking • Involves a victim of any of the following offenses: • Abuse through forced labor • Trafficking for the purpose of slavery, involuntary servitude, peonage, or forced labor • Sexual trafficking of a child or for the purposes of sexual exploitation • (See Sections 566.200, 566.203, 566.206, 566.209, 566.212, or 566.213 RSMo.)

22. CS-23 Time Frames When a CRITICAL EVENT or OTHER event requiring response occurs: The supervisor will notify appropriate management/regional staff ; Management/regional staff will ensure CD Director/Designee is notified immediately; Supervisor will review and submit a CS-23 to Central Office and CC the Circuit Manager and Regional Director via email at: DSS.CD.CriticalEventReport@dss.mo.gov If unable to access email, fax CS-23 form to: 573-526-3971

23. Initiate CS-23 • Categories A, B or C • Business hours - within 3 hours • After hours - by 10 a.m. the following business day Category D or E Within one business day, unless media involved (refer to A, B, C timeframes)

24. CS-23 Procedure • Complete the CS-23; • Conduct CA/N system check on all persons associated with the event; • Include available information from other counties or states; and • Send updated CS-23 to Central Office as new/pertinent information becomes available.

25. Critical Event Tool Kit

26. What is the Critical Event Tool Kit? A collection of tools used to guide a critical event reviewer through the case review process in response to critical events.

27. Critical Event Reviewers Reviewer must not have supervisory responsibility for staff involved.

28. Who completes the reviews? • Category A and B • Reviewer internal to the region of the critical event • Category C • Reviewer external to the region of the critical event Division Director/designee has the discretion to request a review by another region.

29. When is a Critical Event Tool Kit Required? Every critical event requires completion of a CS-23, however; not every CS-23 requires a Critical Event Tool Kit.

30. When is a Critical Event Tool Kit Required? • Category A - A Critical Event Tool Kit is required. • Category B – A Critical Event Tool Kit is only required if CA/N is suspected or a review panel is requested by the Division Director/Designee. • Category C – Critical Event Tool Kit is required. • Category D and E, a Critical Event Tool Kit is not required, unless requested by the Regional Director or Central Office.

31. Critical Event Tool Kit • Case Review of the Critical Event • Log of Prior History (CA/N, AC, FCS and IIS) • Review of Open cases • Review of Priors • Staff Interviews • Recommendations for the Director from Critical Case Review  

32. Case Review of the Critical Event CD-164 RF Used to review Critical Event cases which occurred in a resource home CD-164 Used to review Critical Event Cases which occurred in a family home OR

33. Log of Prior History CD-164A Used to log all prior history including CA/N history and current open or closed AC, FCS or IIS cases

34. Review of Open Cases CD-164 AC Used to review open AC cases CD-164 FCS Used to review open FCS cases CD-164 IIS Used to review open IIS cases

35. Review of Priors CD-164 CAN_P Used to review CA/N priors relevant to the current Critical Event CD-164 FCS_P Used to review CA/N priors relevant to the current Critical Event CD-164 AC_P Used to review CA/N priors relevant to the current Critical Event CD-164 IIS_P Used to review CA/N priors relevant to the current Critical Event

36. Staff Interviews CD-164 B Used to conduct interviews with staff connected to the current event, open case or prior cases (relevant to current critical event)

37. Recommendations for the Director from Critical Case Review CD-164 C • The reviewer will summarize findings from all case records reviewed and interviews noting any practice concerns or practice trends. • Recommendations may include issues related to law, policy, practice and training.

38. Tool Kit Completion: Complete within 10 business days and submit to: DSS.CD.CriticalEventReport@dss.mo.gov Carbon copy Regional Director or if FCCM send encrypted copy to CEO.

39. Critical Event Trends Summary • (Survey Monkey) Upon completion of the Critical Event Tool Kit the designated reviewer will be instructed to complete the Critical Event Trends Summary (Survey Monkey)

40. Critical Event Review Panel • A multi-disciplinary panel designed to bring insight from outside the Division • The goal is to look at agency systems and causal factors which may have impacted the event

41. Critical Event Review Panel • Panel meetings are held for: • All Category C events • All Category B fatalities • Categories A, B (non-fatalities), D and E, only ifrequested by the Division Director/Designee

42. Critical Event Review Panel The reviewer and staff from the incident county present an overview of the incident, comment on the findings, and provide case updates.

43. Who Typically Attends? • The Reviewer • Division Director and Regional Director • Contracted Case Management CEO or designee • Representation from: • Children’s Division Central Office (CD) • Department of Social Services (DSS) • Division of Youth Services (DYS) • Department of Mental Health (DMH) • Division of Legal Services (DLS) • State Technical Assistance Team (STAT)

44. Trends and Action Steps • At each Executive Team meeting, critical events and trends will be discussed for law, policy, practice and training implications statewide. • Regional Directors will discuss findings and address appropriate plans of action within their regions.

45. Management • Reviews • Management Reviews are required when a child is seriously injured or dies during an investigation or there is an open case. • (Section 210.135.3 RSMo.)

46. The End