Iowa Child and Family Service Reviews DRAFT Final Report

1. Iowa Child and Family Service Reviews DRAFT Final Report Statewide IA-CFSR Summary Eight Reviews Conducted: April 2008 to November 2008 Report Date: January 2009 • Submitted by: Krystine L. Lange CFSR State Coordinator Child and Family Services IA Department of Human Services

2. Introduction

3. Introduction Brief History • Our first federal Child and Family Service Review [CFSR] review was conducted in May 2003 • Our Program Improvement Plan [PIP] was completed in August 2005 • Our next CFSR review is in 2010 • Information from our state IA-CFSR reviews, will be utilized to inform our Child and Family Service Plan and the CFSR Statewide Assessment reports to our federal partners.

4. Introduction The federal CFSRs process includes: • Statewide Assessment • Case-level onsite reviews conducted by a team of Federal and State reviewers • Interviews with key State and local stakeholders • State data from AFCARS and NCANDS

5. Introduction The Federal Child and Family Service Reviews: • Are a collaborative effort between the Federal and State Government. • Promote continuous quality improvement in child welfare systems nationwide. • Evaluate State performance relative to the State Child and Family Services Plan. • Identify both the strengths and areas needing improvement in State Child Welfare programs. • In the CFSR the federal government reviews the whole Child Welfare System, not just the public agency [DHS]

6. Introduction IA-CFSR Reviews Conducted: • Between April and November 2008, Iowa DHS conducted eight IA-CFSR reviews in the following counties [one in each service area]: • Polk County • Scott County • Tama County • Pottawattamie County • Winneshiek County • Dickinson County • Cerro Gordo County

7. Introduction • The review included a in-depth review of 32 cases (4 per site); and included interviews with children, family members, foster parents, and service providers. • In addition, in each county, 8 focus groups were conducted with: • DHS/JCO Administrators • Legal Representatives: • GALs, Parents Attorneys, • CASA, FCRB, Assistant • County Attorney • Foster Parent • Providers • DHS & JCO workers • Juvenile Court Judge • QA Staff • Youth

8. Introduction Quality Assurance • This review process is expected to be continued as an ongoing QA mechanism to: • Determine how we perform compared to federal standards • Make system improvements and continue to enhance practice before and after our federal review in 2010 • Efforts are underway to integrate the Judicial Branch Children’s Justice Reviews and IA-CFSR, • An integrated review process will engage child welfare partners and stakeholders as reviewers and provide a more holistic system review and report.

9. Introduction Child and Family Services Review: • The CFSRs analyze strengths and areas needing improvement with respect to seven safety, permanency, and well-being outcomes and seven systemic factors. • The outcomes, which concern safety include: • Safety Outcome 1: Children are, first and foremost, protected from abuse and neglect. • Safety Outcome 2: Children are safely maintained in their homes whenever possible and appropriate.

10. Introduction Child and Family Service Reviews • The outcomes for permanency include: • Permanency Outcome 1: Children have permanency and stability in their living situation. • Permanency Outcome 2: The continuity of family relationships and connections is preserved for children.

11. Introduction The outcomes for well-being include: • Well-Being Outcome 1: Families have enhanced capacity to provide for their children’s needs. • Well-Being Outcome 2: Children receive appropriate services to meet their educational needs. • Well-Being Outcome 3: Children receive adequate services to meet their physical and mental health needs.

12. Introduction The systemic factors include: • Statewide Information System • Case Review System • Quality Assurance System • Staff and Provider Training • Service Array • Agency Responsiveness to the Community • Foster and Adoptive Parent Licensing, Recruitment, and Retention

13. Findings: • The general perception is that DHS is doing better than ever. There is recognition of efforts to: • improve practice; • engage families, the community, and stakeholders; • develop services that are targeted at the specific needs of children and families. • “It’s a different department now.” • At the same time, there is variation and a dramatic range of practice and performance for the department, as well as the court, in different geographic areas. Consistency of practice and performance is a goal for which to strive.

14. Findings: Service Areas are monitoring performance with federal requirements and have created processes that promote safety, permanency and well-being outcomes. In two service areas, performance is consistently near to federal requirements. • Examples of these structures: • Dubuque’s post placement staffings set up concurrent goals, monitor ICWA compliance, etc. • Des Moines pre-placement FTMs assures that the individual needs of children are met as they transition to foster care. • Davenport completes a permanency staffing at 30 and 60 days that documents federal standards.

15. Findings: The Court, Juvenile Court Officers, and Community Partners have also established structures to promote safety, permanency and well-being outcomes. For example: • Juvenile Judges inquire about the frequency and quality of visits between the parents and children in foster care. • Des Moines home/health nurses attend pre-placement FTMs assure that the individual medical needs of children are met as they transition to foster care. • Juvenile Court Services has implemented case reading by supervisor. • Decat and Empowerment committees take on the responsibility to address gaps in the community service array.

16. Overarching Trends and Patterns

17. Overarching Trends & Patterns • DHS and JCS staff are respected and appreciated by child welfare and community partners. • Communities work well together and generally have good relationships through empowerment, Decat, and Community Partnership for Protecting Children [CPPC]. • In most communities, the leadership role of the Judge sets expectations for good outcomes, children involved in court, and permanency for children. • Family Team Meetings contribute to strong practice improvement by engaging parents in partnership for planning and improve outcomes.

18. Overarching Trends and Patterns • Transportation limitations are consistently identified in all areas of the state as the number one practice barrier. • Limitations in available mental health services for children result in use of the Juvenile Justice system as the avenue to access mental health services, when it may not be the most appropriate response to the family and child’s needs. • Complexity of the case plan makes it “incomprehensible” to both professionals and families, creating confusion.

19. Overarching Issues • Changes in the contract services over the last year resulted in challenges and transition issues for the child welfare system. [system changes: Foster Care Licensing and Recruitment, Remedial Service Provider Services, FSRP Services and Safety Services] • Communication and cooperative work towards resolution of problems appears productive.

20. Promising Practices • Family team meetings are used to engage families and give them ownership of the plan developed for family change. Service Areas are creative in improving access to facilitation for family team meetings. [Statewide] • Value and belief in mediation; use of mediation to maintain family connections and achieve permanency for children. [Cerro Gordo] • “Elevate” youth support programs. [Polk, Scott, Linn]

21. Promising Practices • Non-custodial parent search and diligent efforts to engage fathers. [Scott, Polk] • Strong partnership with foster parents to bring about change; examples of foster parents mentoring birth parents.[Council Bluffs; Winneshiek] • Parent Partners programs provide support to new parents in the system. [Dickinson] • Concurrent planning and placement conferences within 30 days of placement. [Winneshiek, Scott] • Tribal partnership to conduct child abuse investigations. [Tama]

22. Promising Practices • Visiting nurses program and partnership with public health nurses. [Polk] • Engagement and commitment of community partners to address disproportionality within the child welfare system: fostering an improved understanding and approach to cultural competency. [Linn] • JCS community liaison working with African American families prior to formal interviews with JCS. [Linn] • Disproportionality Projects are being expanded in the state and cultural competency training is provided across child welfare disciplines and the court.

23. Promising Practices • Family Interaction Pilot: focusing on frequent and meaningful family interaction when a child is in foster care. • Utilization of quality assurance and review processes to improve practice; e.g. supervisory reviews or staffings. [Statewide] • Motivational interviewing and assessment tools enhance JCS practice. • Pre-placement conferences ease the transition of children to foster care and assure their needs are met at placement. [Polk] ‘…since Polk County DHS initiated pre and post removal conferences we have seen major changes that present opportunities for us to improve on a child's placement--both for reunification purposes and as a concurrent plan.  These opportunities include: more active outreach to family members and kin as potential placements;  the development of support services for those placements;  the use of assessment tools to identify placements much earlier on that may be appropriate concurrent plans; and the general encouragement of the good social work that can be done outside of the emergency context.’ [Judge Egly]

24. Promising Practice: Court Leadership • Court leadership has focused expectations on improving outcomes for children in juvenile court. [Statewide] • The court sets expectations for hearing content and attendance. In many areas of the state, children are encouraged to attend and participate in court hearings. • The court has focused on the achievement of permanency to the benefit of children; some judges set hearings at 1-3 month intervals to monitor and track progress to permanency. • The court has initiated the Drug Court model and schedules hearings with the family based on their needs. • Statewide practice and court process improvement embraced by the court: Pottawattamie County “Kids First” committee actively partners with the agency to address child welfare issues. • Children’s Justice Initiative promotes and supports good outcomes for children through child welfare partnerships and court practice improvement.

25. Systemic Factor Patterns and Themes Statewide Information System

26. Statewide Information System Strengths • FACS, DHS child welfare information system, is available statewide and has the capacity to maintain and track required information in the system: legal status, demographic characteristics, location, and goals for the placement of every child in foster care. • JCS utilized Data Warehouse reports for management. • Data reports are effectively used by management and supervisors as one tool to measure performance and improve practice. • There is no child under the care of the department for whom information on there whereabouts is not in the information system.

27. Statewide Information System Concerns: • ICIS [used by Juvenile Court and JCS] and FACS [used by DHS] are separate systems that currently do not communicate. JCS has to do duplicative documentation for FACS, and DHS staff have to enter JCS information in many areas. • FACS, ICIS, and Data Warehouse are not always user friendly and a skilled specialist must be used to access information. • Data reports are a look backwards, whereas current information would allow the use of data as a planning tool. Some data has to be hand-tallied by supervisors because it is not available in the system. • Repetitive entry of data in the system takes valuable worker time. • Some critical information to determine performance is not readily available in the system: e.g. we can not identify number of families in the system and which family has FSRP services.

28. Systemic Factor Patterns and Themes Case Review

29. Case Review Strengths: • There are written case plans for children, which are timely and updated regularly. Supplemental information is provided through court reports. • Family Team Meetings [FTM], which involve the parent and children, with formal and informal support systems are utilized to develop a plan. FTMs are an accepted part of practice. FTMs incorporate the family’s self-identified needs. • Review, permanency, and TPR hearings are timely. • When foster parents attend court, they have an opportunity to be heard and are asked questions from the bench. • Foster Care Review Board and the Juvenile Court conduct at least 6 month reviews.

30. Case Review Concerns: • When FTMs are not used, it is difficult to identify who routinely participates in developing the case plans and the family’s self-identified needs are less likely to be included. Case plans are not always provided to all parties in time for court preparation. JCS does not always involve parents in case planning. • Parent’s attorneys and GALs do not always know or meet with clients until the hearing. • Some focus groups indicated that court reviews may be conducted without hearings and findings based only on a paper review. Families are not always allowed to participate in hearings. • Compelling reasons not to TPR are not always identified and in the file. There are still some areas where the court is reluctant to terminate because an adoptive family is not identified. • The notification process for foster parents, pre-adoptive parents, and relative caregivers is not standardized in the state and notification is not always given and documented. • Post-permanency responsibility is not clear for GALs or service providers.

31. Systemic Factor Patterns and Themes Quality Assurance

32. Quality Assurance Strengths: • The state has developed and implemented standards to ensure that children in foster care are provided quality services that protect the safety and health of children. • There is a wide range of activities directed at improving practice: supervisory case reading, focus on supervisory role in clinical consultation, management use and review of data, QA practice reviews, e.g. review of group home or shelter placements, QA concurrent planning staffings, QA review and consultation for repeat maltreatment and cases with special circumstances. • Data and administrative reports are provided to administrators, supervisors, and workers. • JCS supervisors are reviewing cases with staff to assure quality, and supervisory case reading has been initiated around the state.

33. Quality Assurance Strengths: • There is a feedback loop between QA, practice improvement, policy, and training. QA staff have an influence on policy and practice statewide; e.g. physical form revision; case worker visits; worker/parent visit flag. QA evaluates the quality of services, identifies strengths and needs of the service delivery system, provide relevant reports, and evaluates implemented program improvement measures. • Contractors and providers are becoming more engaged in QA activities in the Service Areas; local surveys and partnership meetings are providing valuable information from providers about quality. • Child welfare stakeholders are engaged in quality assurance activities -- service providers, parents, youth, foster parents, group caregivers, relatives, tribes, court personnel, and others participate in IA-CFSRs.

34. Quality Assurance Concerns: • JCS does not have funding for QA activities and their QA is less developed than DHS. • Providers, parents, youth, foster parents, group caregivers, relatives, tribes, court personnel are generally not directly involved in QA activities in local or service areas. Improvement could be made in educating and involving stakeholders in additional QA processes; e.g. as reviewers in the IA-CFSR. • Data reports are a look back. Easily accessible and current data information would allow for better planning and response to areas of concern. More data is needed to evaluate the effectiveness of strategies for program improvement.

35. Systemic Factor Patterns and Themes Training

36. Training Strengths: • Requirements for pre-service training prior to case assignment are in place for DHS. Staff are getting initial training prior to full case load assignments and it is a good orientation to DHS and practice. • Monthly initial training includes progressive modules with classroom and on-the-job training. Basic skills and knowledge are provided to prepare staff to begin social work practice when supervisor mentoring is provided. Initial and ongoing training is tracked and monitored; records are available for staff. • Service area and local training supplements state training. • More advanced training, e.g. psychological evaluations, has been seen as quality training that is very beneficial. • Cross training with DHS and provider staff is seen as a positive. • Pre-service PS-MAPP is seen as quality training for foster parents. There is a variety of ongoing training available for foster parents. • Licensed relative caregivers are required to have pre-service PS-MAPP.

37. Training Strengths: • JCS considers their new worker training as valuable. • There has been excellent JCS on-going training including Iowa delinquency assessment; functional family therapy, motivational interviewing, and aggression replacement therapy. • Training is provided in a variety of ways, including classroom, web-based online training, interactive cable network training, and interactive distance learning through webinars. Training has moved from centralized training to training in Service Areas around the state, making it more convenient and accessible. • Ample training on process and procedure changes over the last few years. • Specialized training is provided for specialized job responsibilities or caseloads. • State licensed child caring facilities are required to have adequate staff training as a condition of licensure. • Training needs are identified by field staff, a representative training committee reviews curriculum and training plans. • There is a feedback loop for training with QA.

38. Training Concerns: • Minimum standards have not been set for ongoing training requirements for staff per year. • Trainers need to include practice experts that are actually doing the job. • Some DHS training is too basic and there is some repetitious information/skills presented in required training. • Three service areas of the state did not find that initial training adequately prepared staff for job duties or practice orientation. • More training needs to be developed in partnership with the field to improve practical applicability. • JCS staff are assigned case loads prior to training, although mentoring and supervision mitigates the lack of availability of pre-service training.

39. Training Concerns: • Advanced training for proficient social workers is needed. • Advanced training for experienced foster parents is needed. Foster parents may repeat training they have already attended to meet their hour requirement. Foster parents identified some need for advanced training in complex behavioral needs and special needs issues. • Distance and lack of availability of child care make it difficult for some foster parents to attend training. • Youth do not feel foster parent training adequately prepares foster parents for working with adolescents and youth with behavioral needs. • Youth would like foster parents to have training in “de-escalation and anger management” to help their own anger and to deal with youth when they are angry.

40. Systemic Factor Patterns and Themes Service Array

41. Service Array Strengths: • The service array is effective in meeting the needs of the children and families, including in-home and foster care cases. Recent changes are seen as benefiting the individual needs of children by providing focused but flexible services. • An adequate array of accessible services is contracted for and provided to protect children in their own homes and prevent removal. • An adequate array of services to promote timely adoptions is provided and accessible in all areas of the state. • An adequate array of accessible services to youth in foster care to prepare them for independent living and to make the transition from foster care to adulthood are available in all areas of the state. DHS support of Elevate to provide peer support has expanded to 8 chapters, one in each service area. . • The array of services are accessible to families and children in all political jurisdictions covered in the State’s Child and Family Services Plan. • Social workers do what needs to be done for families, despite gaps in services.

42. Service Array Strengths: • Family team meetings are empowering and result in individual needs being identified and addressed by both formal and informal supports. • A rich array of community services exists in the more urban areas of the State. • There has been an increased emphasis on meeting the needs of minority families. • Experienced foster parents know how to access services to meet the needs of individual children. • Community partnerships are aware of gaps in services and work collaboratively and creatively to address gaps. • JCS has a range of services to utilize for children with delinquent behaviors; Functional Family Therapy, tracking, weekend offender programs, day treatment programs, residential care, etc. • Drug partnership grant for substance abuse is seen as a positive addition to the service array. • Youth see Transition Services, PALS, and Elevate as positive resources.

43. Service Array Concern: • Gaps in Services: inpatient substance abuse treatment for adolescents, inpatient and outpatient mental health services for children and parents, parent training, education and skill building; services for co-occurring conditions of children and parents; aftercare substance abuse treatment. • Transportation barriers impact access to drug testing, family interaction, etc. • A range of preventative or early intervention services are not always available, e.g. truancy issues, police shelter placement. • CINA assessments delay implementation of needed services for some families. • Lack of availability of parental skill development impacts progress and permanency. • The transition to the new service array was perceived as negatively impacting timely reunification of children in foster care with their families. • Spanish services and interpreters are not always available.

44. Service Array Concern: • RURAL – RURAL – RURAL impacts accessibility of services. • Families don’t know how to access mental health services for their children with mental/behavioral health needs. Some youth with mental health needs are ending up in the delinquency system by default. • There is a need for services for children with high end needs within the State. • Services to support adoptive families and prevent disruption after placement and finalization have been initiated in the State but needs to expand to meet the post-adoption needs of families. • Skill level, education background, and turnover are affecting the quality of contracted services and impacting safety, permanency, and well-being. • Independent living skill development is not always accessible in rural areas.

45. Service Array Concern: • Dental and orthodontia services are not always available for children on Title XIX. • Services for non-title XIX eligible parents and children are not available. • Supports for non-licensed relatives need to be strengthened; relatives don’t know how to access services to meet their needs and the children’s needs.

46. Systemic Factor Patterns and Themes Responsiveness to the Community

47. Responsiveness to the Community Strengths: • In implementing the provisions of the Child and Family Services Plan, the State engages in ongoing consultation with tribal representatives, consumers, service providers, foster care providers, the Juvenile Court, and other public and private child- and family-serving agencies and includes the major concerns of these representatives in the goals and objectives of the Child and Family Services Plan. • Child Welfare Stakeholder Panel • Child Welfare Advisory Committee • Service Area quality assurance committees • Community Partnership for the Protection of Children committees • De-categorization committees • Initiative specific collaboration: e.g. disproportionality; Service Array planning

48. Responsiveness to the Community Strengths: • The State’s services under the Child and Family Services Plan are coordinated with services or benefits of other federal or federally assisted programs serving the same population. • School based programs: Area Education Agency; Early Access • Public Health: public health nurses; substance abuse treatment; visiting nurses program • TANF: economic support programs • Corrections: Prisons • Mental Health: mental health centers, children’s mental health waiver • Domestic Violence: CPPC and DV training programs • Tribes: Meskwaki MOA; Sioux City Tribal community • Strong JCS, DECAT, DHS, Foster Parent, Court, and community services partnerships work effectively to meet family and children needs at the local level.

49. Responsiveness to the Community Concerns: • Tribal partnership on the Child and Family Service Plan could be strengthened. • Formal protocols to address Tribal concerns on individual cases as well as systemic issues are needed to build partnership and credibility with Tribes. • Tribal Memorandum of Agreements, Iowa Code 232B, and tribal court provisions are not known by all staff and impact working with Iowa’s tribes. • Continued efforts need to be made to engage education in communities to assure youth in foster care succeed in school.

50. Systemic Factor Patterns and Themes Licensing and Recruitment