Senate Health and Human Services Committee

Interim Charge Presentation

Judge John Specia, DFPS CommissionerFebruary 20, 2014

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Interim Charge

• Review the Department of Family and Protective Services’ efforts to reduce child fatalities.

• Review the process by which the Department of Family and Protective Services collects and uses data to evaluate agency performance and improve outcomes for children in the Child Protective Services system.

• Make recommendations to ensure the process effectively uses data to strategically improve caseworker performance, and identify and improve upon deficiencies within the system and improve overall outcomes for children and reduce child fatalities.

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Presentation Overview

• Child Fatalities o FY 2013 datao Child fatality audito Plan to address child safetyo Prevention efforts

• Data Useo Current data resources and toolso Current uses of datao Plans to improve use of data

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Part OneChild Fatalities

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Child Protective Services– FY 2013

In Fiscal Year 2013 - • 7,159,172 children lived in Texas

• 160,240 abuse/neglect investigations were completed by CPS

• 27,924 children were in the state’s conservatorship on August 31, 2013

o 16,676 in foster care

o 10,059 in kinship care

o 1,189 in other settings

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Confirmed Abuse/Neglect Fatalities in the General Population in FY 2013

2007 2008 2009 2010 2011 2012 2013500

600

700

800

900

1000

1100

100

200

300

400

500

9941,024 1,016 1,024

973

882

804

223 213

280

227 231212

156

Reported Child Fatalities

Abuse/Neglect Fatalities

Rep

ort

ed C

hil

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atal

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Ab

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/Neg

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Fat

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Child Fatalities in the General Population in FY 2013

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804Reported Child Fatalities Statewide

(Includes CCL, CPS, RCCL)

156Confirmed child abuse or neglect related fatalities

72Prior CPS history

23Open CPS case at time of death

49No CPS case at time of death

84No prior CPS history

648Fatalities unsubstantiated as

child abuse or neglect

In FY 2013, CPS completed 160,240 investigations of abuse or neglect

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Child Fatalities in the General Population

DRAFT Data Chart on Causes of Death

Abuse41% (64)

Neglect59% (92)

Child Fatalities in TexasFY 2013

Total - 156

Neglect fatalities in-clude:▪ Drowning▪ Unsafe Sleep▪ Medical Neglect

Abuse fatalities include:▪ Blunt Force Trauma▪ Stabbing▪ Suffocation

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General Population– Safety Factors

• In child fatality cases, factors that presented safety threats to the child included:o Lack of protective capacity of the caregivero Repeat maltreatment to the child o Access to a swimming poolo Access to a firearmo Inappropriate sleeping arrangementso Children age three and under represent 80% of all child

fatalities from abuse or neglect

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Child Fatalities in Conservatorship in FY 2013

2007 2008 2009 2010 2011 2012 201320000

25000

30000

35000

40000

45000

50000

0

5

10

15

20

47,10444,928

40,84042,890

44,780 45,694 45,159

5

3

0

4

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10Children in Conservatorship

Abuse/Neglect Fatalities in Conserva-torship

Ch

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Ab

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Child Fatalities in Conservatorship

• In FY 2013, 10 children in DFPS conservatorship died as the result of abuse or neglect by the child’s caregivero DFPS Conservatorship includes both foster care and

kinship homes

o 7 child fatalities occurred in foster care

o 3 child fatalities occurred in kinship care

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Child Fatalities in Conservatorship – Foster Care

• In FY 2013, there were 7 abuse or neglect related fatalities in foster care placements:

o Physical abuse by caregiver – 1 child

o Unsafe sleep – 2 children

o Drowning – 2 children

o Suicide – 1 child

o Neglect/seizure-related – 1 child

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Child Fatalities in Conservatorship – Kinship Care

• In FY 2013, there were 3 abuse or neglect related fatalities in unverified kinship care placements:

o Drowning – 1 child

o Gun-related accident – 1 child

o Neglectful supervision – 1 child (kinship caregiver left the child in the care of the biological parents who then abused the child)

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Audit of Child Fatality Review Process

• In FY 2013, DFPS Internal Audit was directed to conduct an audit of the existing child fatality review processes

• The audit found that DFPS needed to make efforts to identify lessons learned and ensure the agency has a clear and consistent response to each fatality

• In particular, it was noted that policy and procedures are maintained in multiple documents and not consistently presented in a logical flow, which requires staff to piece together information from various places to perform their job functions

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Child Safety Plan

• DFPS developed a child safety action plan that includes implementation of the recommendations in the audit and changes proposed in response to specific child fatality cases, identified trends, or as a recommendation from a child safety forum with providers.

• Areas addressed in the child safety plan include:o Child fatality review processo Kinship Careo Foster Careo DFPS training and casework practiceso Regulation of contracted providers

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Child Safety Plan– Reviews of Child Fatalities

• In response to the audit findings and recommendations, DFPS overhauled the child fatality process to be more consistent, transparent, and comprehensive:o Restructured the child fatality review process and clarified the role of

external reviewers to ensure thorough review of fatality investigations

o Streamlined and clarified internal fatality review policy and protocols to ensure consistent application across all regions. Consolidated all fatality related procedures into a separate manual

o Implemented centralized, comprehensive data collection that allows for real time analysis of fatalities

o Established an ongoing process to analyze issues and trends identified during child fatality reviews in an effort to prevent child fatalities.

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Child Safety Plan– Kinship Care

• In FY 2013 there were 3 fatalities in kinship care, though there were none in FY 2012. Each of the 3 fatalities was related to improper supervision. To address concerns, DFPS:o Updated the manual provided to all kinship caregivers to include more

information on ensuring child safety.o Reviewed kinship policies, procedures, and rules to ensure that they

are up-to-date and that safety is emphasized.o Strengthen ongoing assessment of child safety risks during home visits.o Is conducting an additional safety check on all children aged 3 and

under who are in kinship placements.o Is updating the DFPS home assessment for kinship placements to

ensure that caseworkers clearly identify risks during the family’s home study and take appropriate steps to address those identified risks.

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Child Safety Plan – Foster Care

o With 90% of children in foster care placed with private providers, how DFPS regulates and monitors those providers is critical. DFPS is taking the following actions:o In Region 7, conducted unannounced visits in foster/adopt homes

with very young children and conducted a review of frequent visitors to ensure appropriate background checks had been completed (November 2013)

o Conducted child safety forums with providers across the state (completed December 2013)

o Strengthening minimum standards related to the screening of foster parents (See slides 20-21)

o Conducting a contract monitoring audit to assess the process for evaluating residential provider performance, with a focus on child safety and quality of care

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Child Safety Plan– Strengthening DFPS Training

• In 46% of child fatalities, CPS had prior involvement with the family. In order to ensure CPS workers have the training to identify safety risks, DFPS is taking the following steps:o Conducted a statewide training on safety for all CPS foster/adopt staff

(November 2013)

o DFPS is also updating training for caseworkers on identifying and addressing safety concerns. Training will focus on better communication between CPA and CPS staff. (Spring 2014)

o Increase training for Human Services Technicians (HST), who often transport children to services, to enhance their abilities to recognize safety issues. Because HSTs are an additional set of eyes on children, they serve as another opportunity to observe and ensure that child’s safety. (Spring 2014)

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Child Safety Plan– Strengthening Minimum Standards

• At the April 2014 DFPS Council meeting, DFPS is proposing changes focused on enhancing safety in foster care:o Require child placing agencies (CPAs) to implement a plan to

evaluate the accuracy of foster home screenings and the quality of supervisory visits.

o Require a more comprehensive foster home screening process by CPAs to include:

additional law enforcement checks assessment of support systems required interviews with adult children additional reference interviews additional information on finances

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Child Safety Plan– Strengthening Minimum Standards

• Proposed Changes, Continued - o Require child placing agencies (CPAs) to make more unannounced

visits to the foster home (2 per year). During the visits, the CPA will be required to look at: o Stressors in the home o Appropriateness of supplementary caregivers for the children o Changes to the household o Changes to household makeup

o Require CPAs to improve processes for identifying safety risk factors prior to children being placed in the home.

o Once the homes are verified, CPAs will be required to conduct more thorough visits and continually identify and address risk factors in the home.

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Abuse/Neglect Prevention Efforts

• Public awareness campaigns to educate about safetyo Help and Hope – connecting families with community

resourceso Room to Breathe – promoting safe sleep for infantso Watch Kids Around Water - drowning preventiono Look Before You Lock - preventing deaths in hot cars

• DFPS safety webpageo Section of DFPS website dedicated solely to safety

informationo ChildSafety@dfps.state.tx.us – email box for safety

questions or concerns

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Targeted Prevention Efforts

• Project HIPo Targets certain high risk families who have had a recent

new birth• Project HOPES

o Community-based programs focusing on high risk families with children age 0-5

• STARo Community providers in every Texas county who provide

family crisis counseling and emergency respite care

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Part TwoData Use

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Primary Data Source Systems

• IMPACT o Comprehensive abuse/neglect case management systemo Addresses the full range of protective services, including intake,

investigations, family-based safety services, foster care, and adoptiono The infrastructure is 17 years old and resources required for system

maintenance are expensive and increasingly hard to findo Usability has decreased over time, particularly compared to current web

applications

• Data Warehouseo Subset of the information in IMPACTo Official data source for non-financial agency reporting and data analysiso Integrates data from multiple systems o Makes data more manageable, accessible, and timelyo Enables management and workers to make more informed decisionso Creates tangible reports that can be used as management tools

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Using Data Strategically –Foster Care Redesign

• Foster Care Redesign is an outcome-based model in which: o Data reported by Single Source Continuum Contractors and

DFPS data are used to evaluate contractor performance

o DFPS is collaborating with leading research organizations to:

Establish baselines (using legacy system data) and targets associated with selected measures (e.g., permanency, placement stability) to assess contractor performance

Implement a continuous quality improvement process that will provide opportunities for the contractor to make ongoing adjustments to meet established performance outcomes

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Using Data Strategically –CPS Performance Dashboard

• CPS has reviewed all available data to establish key measures related to safety, permanency and well-being

• Data will be combined with case reads to examine the quality of casework at critical points to understand how system is working and where to target resources to most effectively improve outcomes

• Supports a reasoned, planned approach to make necessary policy and process improvements

• Provides a method for tracking whether improvements are resulting in better outcomes

• Full implementation anticipated by May 2014

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Plan to Improve Data Collection and Access

• IMPACT Modernization o 83rd Legislature provided initial funding for IMPACT modernizationo Project includes implementation of Business Intelligence tool o Will streamline caseworker documentation and improve usability

of data, access, and data-driven decision makingo The following initial improvements will be available by the end of

2014: Business Intelligence to improve the usability of the system

for caseworkers, prompting them to take case actions Online data book with data that can be accessed and

manipulated by the public External access to Court Appointed Special Advocates (CASA)

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Long-term Vision for Data Use

• Using Predictive Analysis to Support Decision Makingo The modernization of the IMPACT case management system

lays the foundation for predictive analytics – modeling and data-mining that analyze current and historical facts to make predictions about future, or otherwise unknown, events

o DFPS is exploring opportunities in critical business areas to use Predictive Analytics to make better decisions, more quickly, and with less expense