Front End Front End Redesign: Redesign: Serving Serving

Children Effectively Starting Children Effectively Starting with the Right Assessmentwith the Right Assessment

November 18th, 2004Dependency Court Improvement Summit

Orlando, FL

Today’s PresentersToday’s PresentersGregory J. Kurth, MA Gregory J. Kurth, MA

Executive Vice PresidentExecutive Vice President

Dr. Fotena Zirps, PhD.Dr. Fotena Zirps, PhD.

Senior Vice President for Program Senior Vice President for Program ExcellenceExcellence

Why RedesignWhy Redesign

Orange/Osceola

State

Nation

7.0

5.3

4.0

Abuse Reports (% of Child Population)

Substantiations (% of Reports)

Removals (% of Substantiations)

Removals (per 1,000 of Child Population)

8.2%

4.2%

8.9%

31.6%

36.5%

29.4%

20.3%

25.6%

26.4%

Essentially, the Removal Essentially, the Removal Rate per 1000 in Orange Rate per 1000 in Orange

and Osceola wasand Osceola was

32 % above State Average32 % above State Average

75% above National 75% above National Average Average

Some FactsSome Facts 59% of children who died of abuse 59% of children who died of abuse

and/or neglect in 2002 had 5+ and/or neglect in 2002 had 5+ major risk factors:major risk factors:

Patterns of escalation or frequency of Patterns of escalation or frequency of

incidents of abuse or neglect (47% of incidents of abuse or neglect (47% of deaths).deaths).

Caregiver unable to meet children’s Caregiver unable to meet children’s immediate needs (44% of deaths).immediate needs (44% of deaths).

Caregiver’s age, mental health, alcohol Caregiver’s age, mental health, alcohol or substance abuse affected their ability or substance abuse affected their ability care for the child ( 42% of deaths).care for the child ( 42% of deaths).

Caregiver’s criminal history presented a Caregiver’s criminal history presented a potential threat of harm (31% of deaths).potential threat of harm (31% of deaths).

… … More FactsMore Facts

Pattern of escalating and/or Pattern of escalating and/or continuing incidents of domestic continuing incidents of domestic violence (25% of deaths).violence (25% of deaths).

Living conditions were physically Living conditions were physically hazardous to the health of the child hazardous to the health of the child (23% of deaths).(23% of deaths).

Caregiver was unable or unwilling to Caregiver was unable or unwilling to protect the child from abusive protect the child from abusive caregivers/paramours (25% of caregivers/paramours (25% of deaths).deaths).

Why Implement Change?Why Implement Change?

Many Children are Entering Care Many Children are Entering Care Unnecessarily;Unnecessarily;

Some child/abuse victims may be Some child/abuse victims may be remaining home who should be placed;remaining home who should be placed;

In-Home families are not receiving In-Home families are not receiving effective child protective services;effective child protective services;

The System has not clarified the The System has not clarified the difference b/w Risk and Safetydifference b/w Risk and Safety

Workers lack prescriptive guidelinesWorkers lack prescriptive guidelines

Front-end Redesign Front-end Redesign PrinciplesPrinciples

Community InvolvementCommunity Involvement Safety Focus Safety Focus Engagement Based Engagement Based

PracticePractice PrescriptionPrescription System IntegrationSystem Integration ResponsivenessResponsiveness Relentless Management Relentless Management

& Quality Improvement& Quality Improvement

SafeSafetyty

versversusus

RisRiskk

Now or Near FutureNow or Near Future

Higher DegreeHigher Degree

Prevention (short Prevention (short term)term)

Longer TermLonger Term

Lower to Moderate Lower to Moderate DegreeDegree

Mitigation (long Mitigation (long term)term)

Potential Harm

New Tools for the New Tools for the Front-End ProcessFront-End Process

SAFETYSAFETY ((CChild hild EEndangerment ndangerment SSafety afety AAssessment ssessment PProtocol -- rotocol -- CESAP)CESAP)

RISKRISK (California Family Risk (California Family Risk Assessment: Structured Decision Assessment: Structured Decision Making Risk Tool)Making Risk Tool)

CChild hild EEndangerment and ndangerment and SSafety afety AAssessment ssessment

PProtocolrotocol

CESAP RequirementsCESAP Requirements

A ‘life of the case’ A ‘life of the case’ protocol.protocol.

Assessing moderate to Assessing moderate to severe harm immediately severe harm immediately or in the near future.or in the near future.

Safety Determination Safety Determination Form.Form.

Safety Plan.Safety Plan.

Safety Determination FormSafety Determination Form For Child Protective For Child Protective InvestigationsInvestigations::

Within 24 hours of CPI seeing the child. Within 24 hours of CPI seeing the child. Whenever circumstances suggests Whenever circumstances suggests

change in child’s safety status change in child’s safety status (I.e. new (I.e. new person(s) in the home; illness of child, etc.).person(s) in the home; illness of child, etc.).

Every 5 working days following the Every 5 working days following the determination that any child in a family determination that any child in a family is is unsafeunsafe and a safety plan is and a safety plan is implemented implemented (Until evidence and (Until evidence and circumstances indicate otherwise) .circumstances indicate otherwise) .

At the conclusion of the investigation.At the conclusion of the investigation.

Safety Determination Safety Determination Form Form (continued)(continued)

For Child Protective For Child Protective ServicesServices:: Within 5 working days after initial case Within 5 working days after initial case

assignment.assignment. Every 3 months from case opening. Every 3 months from case opening. When considering closure of an in-home case.When considering closure of an in-home case. Every 5 working days following the Every 5 working days following the

determination that any child in a family is determination that any child in a family is unsafe and a safety plan is implemented.unsafe and a safety plan is implemented.

Whenever evidence or circumstances suggest Whenever evidence or circumstances suggest that the child’s safety status may have that the child’s safety status may have changed.changed.

ExerciseExercise

1

ExerciseExercise

2

Safety PlanningSafety Planning Must address issues identified on CESAP.Must address issues identified on CESAP. Must ensure safety of child if implemented.Must ensure safety of child if implemented. Must not be used if child’s safety can’t be Must not be used if child’s safety can’t be

assured.assured.

Safety Plan TerminationSafety Plan Termination

When safety factors are no longer evident.When safety factors are no longer evident. Must be predicated on safety and not ‘task Must be predicated on safety and not ‘task

completion.’completion.’ Risk may be present and ongoing.Risk may be present and ongoing.

CORRECT SERVICESCORRECT SERVICES

CORRECT MODE OF COMMUNICATIONCORRECT MODE OF COMMUNICATION

CORRECT TIMINGCORRECT TIMING

CORRECT AMOUNTCORRECT AMOUNT

CORRECT CONDITIONSCORRECT CONDITIONS

CORRECT MONITORINGCORRECT MONITORING

Essential Elements of a Safety Plan

ExerciseExercise

3

“Here’s the real test!”

CCalifornia alifornia FFamily amily RRisk isk AAssessmentssessment

California Family Risk California Family Risk AssessmentAssessment

Quantifies a Risk Score of Low, Medium, Quantifies a Risk Score of Low, Medium, High, Very HighHigh, Very High

Composed of two Indices: Neglect and Composed of two Indices: Neglect and AbuseAbuse

Like CESAP, assesses current allegationsLike CESAP, assesses current allegations Unlike CESAP, looks at prior abuse and Unlike CESAP, looks at prior abuse and

CPS historyCPS history Assesses characteristics of well-being of Assesses characteristics of well-being of

childrenchildren

Putting It All TogetherPutting It All Together

SAFETY:SAFETY: If SAFETY FACTORS exist and SAFETY PLAN is If SAFETY FACTORS exist and SAFETY PLAN is

appropriate, refer to VPS or Court-ordered PS;appropriate, refer to VPS or Court-ordered PS; If no SAFETY PLAN is viable, then refer for If no SAFETY PLAN is viable, then refer for

OHCOHC

RISK:RISK: NO SAFETY FACTOR existsNO SAFETY FACTOR exists If low to moderate, refer for community servicesIf low to moderate, refer for community services

Risk Safety Willing and/or Able

Service Alternative

Low risk Safe Willing/Able CBI or I&R

Low risk Safe Unwilling/Unable Nothing

Low risk Unsafe Willing/Able VPS

Low risk Unsafe Unwilling/Unable PS or OHC*

Moderate risk Safe Willing/Able CBI

Moderate risk Safe Unwilling/Unable PS or Nothing*

Moderate risk Unsafe Willing/Able VPS or PS

Moderate risk Unsafe Unwilling/Unable OHC

High risk Safe Willing/Able Highly Unlikely Scenario

High risk Safe Unwilling/Unable PS

High risk Unsafe Willing/Able PS

High risk Unsafe Unwilling/Unable OHC

Family Assessment and Service Tool (FAST)

*Depends on legal sufficiency

The Resource SpecialistThe Resource SpecialistFunctions

as a ‘resource’ for placement

stabilization via consultation.

Works closely with the CPI on

diverting children from coming into

care.

Conducts and maintains a ‘mapping’

of the community’s ‘traditional’ and ‘non-traditional resources.

Assists the CPI in the

assessment of

safety vs. risk.

Consults with

the CPI in the

development of a safety

plan.

Assists in generating

referrals for CBA

services.

Continuously

assesses ‘gaps’ in services.

Assists the CPI in the diligent search for

relative placements.

Community Based Community Based InterventionsInterventions

Where the risk to the child is deemed Where the risk to the child is deemed lowlow to to moderatemoderate, FSMO will fund , FSMO will fund services that will:services that will:

Limit number of families entering the Limit number of families entering the child welfare system;child welfare system;

Engage families in the change process Engage families in the change process at every level;at every level;

Use safety/risk assessment to inform Use safety/risk assessment to inform case management decisions;case management decisions;

Marshalling of local services to Marshalling of local services to children & families.children & families.

“Check out our RFQ on www.fsmetroorlando.org for a Diversion/Prevention Initiative!”

SummarySummary

Ineffectively rendered child Ineffectively rendered child protective services are protective services are dangerousdangerous to to children and destructive of families. children and destructive of families.

Focus on situations where children’s Focus on situations where children’s safety is threatened and rely on the safety is threatened and rely on the community to respond to lower risk community to respond to lower risk situations. situations.

We must engage families in the We must engage families in the effort to keep their children safe. effort to keep their children safe.

Summary Summary continuedcontinued

Services must be relevant to the Services must be relevant to the issues presented by families and must issues presented by families and must be rendered with a sense of urgency.be rendered with a sense of urgency.

The new system of care must have the The new system of care must have the capacity for monitoring its capacity for monitoring its effectiveness and for selfeffectiveness and for self correction.correction.

The EndThe End

2600 Technology Drive, Suite 250, Orlando, Florida 328042600 Technology Drive, Suite 250, Orlando, Florida 32804Tel: 407-398-7975 Fax: 407-578-0074Tel: 407-398-7975 Fax: 407-578-0074

www.fsmetroorlando.org www.fsmetroorlando.org