Case Management Side-by-Side and In-Depth Review Report

           

Region: Southeast                      Date of Review:               October 11-15, 2010    Lead Agency: ChildNet, Inc. Period under Review:   January 1, 2010 thru October 15, 2010 

1. Introduction Southeast Region Quality Assurance opted to conduct the Side-by-Side and In-Depth reviews semi-annually. Each of the two reviews will assess sixteen (16) cases. The permanency goal identified in the Florida Safe Families Network (FSFN) serves as the basis for case selection. This review included cases that were identified in FSFN with the following goals: Maintain and Strengthen (4 ), Reunification ( 6), Permanent Guardianship (0), Permanent Guardianship to a Relative (0 ), Adoption (2 ), or Another Planned Permanent Living Arrangement (APPLA) (4 ). Upon reviewing the actual cases however, reviewers discovered that four (4) of the sixteen goals changed between sample selection and review of the files. 2. Overall Performance in Achieving Safety, Permanency and Well-being It is important to note, that since the fourth quarter Side-by-Side review in 2009/2010, ChildNet has undergone a major reorganization of their Client Services Division. In undertaking this change they understood the inherent risk, in the short term, of a negative impact on performance. ChildNet administration anticipates however that the changes will result in significant improvements in the near future. ChildNet, Inc. achieved an overall performance rating of seventy percent (70%) for this first semi-annual review. An assessment of the overall safety, permanency and well-being of the 16 cases that were reviewed revealed three cases where the reviewers were unsure that the children were likely to live in a safe environment with their needs met during the next twelve months. The situation for one youth could not be ascertained because the youth was on run-a-way status and this created a concern for future living stability. The second ongoing concern pertained to a youth who was safe in his residential treatment program (RTC), but had to undergo a suitability assessment every thirty-day for redetermination and the record contained no documentation indicating placement options were being explored in the event he was to be stepped down from his current placement. The third concern relates to a court ordered in-home protective supervision case where the mother, who is a caregiver, appears to be abusing prescription medications that could impair her ability to care for her children. All three ongoing concerns were brought to the attention of the appropriate ChildNet staff to be addressed and remedied. The table below shows the seven outcomes measured and includes a description of each measure for easy reference. The Federal Child and Family Services Review (CFSR) standards include items that are not directly addressed under Safety, Permanency and Well Being but

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have an impact on achieving the outcomes. The data contained in the following table also shows the total percentages for each outcome measure during ChildNet’s 2010/11 semi-annual and 2009/10 quarterly side-by-side reviews (note: the first quarterly review for 2009/10 was waved statewide by Central Office Quality Assurance due to a special review of psychotropic medications). Table1 ChildNet, Inc Side-by-Side Outcome Measure with Percentages for 2009-10 & 2010-11

 

 

Outcome  Measures 

2009‐10  2009‐10  2009‐10  2010‐11 

Q2  Q3  Q4 1Semi‐Annual 

Safety Outcome 1. Children are, first and foremost, protected from abuse and neglect  100%  100%  73%  94% 

Safety Outcome 2  Children are safely maintained in their homes whenever possible and appropriate  52%  70%  81%  85% 

Permanency Outcome 1 Children have permanency and stability in their living situations  78%  82%  84%  62% 

Permanency Outcome 2  The continuity of family relationships and connections are preserved for children  75%  75%  77%  63% 

Well‐Being Outcome 1  Families have enhanced capacity to provide for their children’s needs  76%  85%  99%  73% 

Well‐Being Outcome 2  Children receive appropriate services to meet their educational needs  100%  76%  67%  67% 

Well‐Being Outcome 3  Children receive adequate services to meet their physical and mental health needs  74%  82%  73%  58% 

Overall Performance Total Percentages  74%  80%  85%  70% 

 Federal CFSR Measures   64%  79%  97%  78% 

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The following graph is provided as a supplement to the data in the table above to provide a visual representation of the outcome measures for each review period.

 Graph 1 ChildNet, Inc Side-by-Side Graph of Outcome Measures 2009-10 & 2010-11

 

Federal Child and Family Services Outcome Performance Achievement Safety Safety outcome utilizes initial and on-going family assessments to measure how well the agency is doing in keeping children safe from re-abuse, and ensuring children can remain safely in their homes whenever possible and appropriate.

Graph 2 ChildNet Safety Outcomes  

Standards assessed for Safety Outcome 1 includes incidents of re-abuse (new reports of maltreatment classified as substantiated or verified) on in-home and out-of home cases. Only

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one report was determined to have verified findings. This report was verified for abandonment following a child protective investigation of a case in which the family was under court ordered in-home protective supervision and the mother refused to pick-up the child upon his release from the Department of Juvenile Justice- Juvenile Intervention Facility (DJJ-JIF). The Broward Sheriff’s Office Child Protective Investigator (CPI) and the ChildNet Child Advocate (CA) attempted to work with the mother and provide services to help ameliorate the circumstances leading to the current situation. The mother initially agreed to the services, but failed to follow through. As a result of the mother’s lack of cooperation the CPI determined the youth was at risk and he was taken into protective custody and placed in a licensed sheltered facility. Standards for Safety Outcome 2 assess on-going family assessments, service referrals, addressing immediate and emerging safety concerns, and preventing re-entry into out-of-home care. The criteria for completing the initial family assessment standard requires that it be completed within 15 days of case transfer from the Child Protective Investigations to the Community Based Care agency. In this review, ChildNet had three cases requiring an initial assessment. Of the three applicable cases all contained initial family assessments, one was completed timely and two were not. All three initial family assessments were comprehensive with no immediate or emerging risk factors identified.

The need for service referrals was identified for fourteen (14) of the sixteen (16) cases reviewed. Services were already in place for two of the cases prior to the period under review

and therefore were considered Not Applicable for rating this measure. Of the two (2) cases with no referrals, one case was reopened for a change of placement from one relative caregiver to another and no further action was taken because the case was closed when the youth aged out prior to the date of the review. In the second case the youth needed academic tutoring but no referral was made. ChildNet’s administration was notified of the continuing need. An updated family assessment was due during the review period for fourteen (14) of the sixteen (16) cases. Reviewers observed updated family assessments for nine (9) of the fourteen (14) cases. The updated family assessments identified seven immediate or emerging safety concerns and reviewers determined each was appropriately addressed. The remaining two (2) of the nine (9) family assessments completed identify no immediate or emerging safety concerns. Permanency Permanency outcomes assess how well we are working with families and achieving permanence for children.

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 Graph 3 ChildNet_ Permanency Outcomes

Permanency Outcome 1 showed a steady upward trend in each quarter of 2009/10; however, the results of the first semi-annual Side-by-Side review of 2010/2011 showed a 22 point decrease from eighty-four percent to sixty-two (84% to 62%) as indicated in Graph 1 above. Items adversely affecting this outcome measure were children who re-entered care within 12 months of being reunified, concerted efforts to locate relative placements, and conducting exit interviews for children who moved from a licensed placement. Also, the review item related to filing petitions for Termination of Parental Rights (TPR) of children who had been in out-of-home care for twelve (12) of the most recent twenty- two(22) months was rated low because there were no compelling reasons documented for most of the children as to why a TPR petition was not filed.

The findings for Permanency Outcome 2 were relatively consistent throughout the 2009/2010 review year. The current review however achieved a rating of sixty- three percent (63%) which is a decrease from seventy–seven percent (77%) in the fourth quarter of 2009/2010. The primary reason for this decrease relates to ensuring concerted efforts to facilitate visitation with fathers and encouraging and supporting both parents in decision making about their child’s needs. Well-Being Well-being assesses how well the CBC is doing in assuring families have the enhanced ability to meet their children’s needs as well as ensuring the educational, physical, dental, and mental health needs of the child/children are being met.

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Graph 4 ChildNet_Well-Being Outcomes  

 

Well-Being Outcome 1 includes standards for the assessment of service needs for case participants and engagement of those individuals in case planning and activities. ChildNet steadily trended upward in these ratings last year and closed out the year with a rating of ninety –nine percent (99 %.) As of this current review they slipped to a rating of seventy-three percent (73%) which was slightly below the rating of their second quarter last year. Although ChildNet did very well one-hundred percent (100%) in designing case plans which achieved permanency and safety and stability through appropriate tasks for the case participants; attention is needed to providing pre-independent living assessments, educational plans, normalcy plans and transition planning services for youth with the goal of APPLA. Attention in also needed to service workers’ frequency of visits to the parents and rated only fifty-eight percent (58%) for mothers and sixty-seven percent (67%) for fathers. Children rated the highest at ninety-four percent (94%) and the quality of the visits that occurred rated eighty-eight percent (88 %.) When rating Outcome Well Being 2, consideration is given to the identification of educational needs and provision of services to effectively reduce or resolve the needs. As evidenced in Graph 4.3, ChildNet was in a steady downward trend last year but seems to have leveled off achieving a sixty- seven percent (67%) rating in both the fourth quarter of last year and the current review. Well-Being 3 assesses whether the child’s physical, dental, mental and behavioral health needs were assessed and services provided to address identified needs. ChildNet received an overall rating of fifty-eight percent (58%) for this measure which reflects a significant decline from the 2009/2010 reviews. In several instances case files lacked sufficient documentation for reviewers to determine if the child’s physical, dental, mental and behavioral health needs were met. Although children may be receiving assessments and follow-up care, the lack of information in the files made it impossible to confirm. The need for documentation of medical records is of utmost importance and is a requirement in rule and practice. Caregivers play an integral part in keeping case managers informed of the child’s medical history and documenting medical/dental appointments and the need for follow-up in the Child Resource Record (CRR.)

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However, there was a lack of follow-up by the case manager in obtaining and documenting medical records.

3. Practice Trends A. Assessment This section considers how well the agency is doing in conducting critical assessment activities and includes initial and on-going family assessments; assessment of needs of the child, parent and caregiver; completion of a pre-independent living assessment for 13-15 year olds, and the completion of exit interviews. Completion of initial and on-going family assessments is critical to effective case management. Reviewers found Child Advocates completed initial assessments as required in all three (3) of the applicable cases with a rating of one-hundred percent (100%.) Of the sixteen (16) case records reviewed fourteen (14) cases required an updated assessment during the period under review. Only nine (9) of the fourteen (14) case records contained documentation confirming updated family assessment were completed. Documenting initial and on-going family assessments in Florida Safe Families Network (FSFN), the official system of record, is a statewide expectation. Of the on-going assessments completed, reviewers determined they were comprehensive and covered changes in the family, long and short term implications of the changes, evaluated emerging signs of danger, and reviewed case plan goals to identify barriers. Case file documentation reflects four (4) of the nine (9) updated family assessments were not completed timely. ChildNet demonstrated strength with one-hundred percent (100 %) ratings for initial assessments, safety assessments prior to reunification or placement in an unlicensed out-of-home setting, management of risk to prevent re-entry after reunification, and completing assessments for residential group care when required. They attained mid-range ratings of seventy-five percent (75%) on multi-disciplinary staffing for children with more than two placements, ongoing assessments of the children’s needs, and ongoing assessments of the fathers’ needs. They were rated at seventy-three percent (73%) for ongoing assessments of the mothers’ needs and for assessing the child’s educational needs. Areas needing improvement were identified for several assessment measures. ChildNet received ratings of sixty-seven percent (67 %) for assessment of the needs of the out-of-home care provider, and for the mental and behavioral health needs of the child. Updating family assessments rated sixty-four percent (64 %), followed by assessing the physical health needs of the child which was rated at six-two percent (62 %.) Assessment measures possibly needing priority in improvement are dental health needs assessment for the child which rated eighteen percent (18 %), followed by pre-independent living assessments, and exit interviews which were both rated at zero percent (0%.)

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B. Family Engagement This section measures whether ChildNet is engaging and supporting families in decision- making. ChildNet’s success in engaging families was evaluated. The standards considered when measuring engagement are addressed below starting with those that rated the highest and ending with the areas needing the most improvement. The current Side-by-Side review revealed ChildNet practice in “maintaining community connections” and obtaining informed consent for children prescribed psychotropic medication are areas of strength. Both measures achieved a one-hundred percent (100%) rating. ChildNet attained ratings of seventy-five percent (75%) in the areas of engaging the family in the case planning process; ongoing assessment of fathers’ needs and making concerted efforts to engage fathers in services. ChildNet practice achieved seventy-three percent (73%) in making concerted efforts to arrange visitation with mother and seventy-one percent (71 %) for ensuring engagement of services for mother in the applicable cases. Reviewers further observed that “sibling visits” occurred when siblings in out-of-home care were placed separately in sixty-seven percent (67%) of the applicable cases. Areas needing the most improvement under family engagement include notification to parents when their child experiences a change of placement. This measure was rated fifty percent (50 %). Another area needing attention is concerted efforts encourage and support mother and father’s participation in making decisions about their child’s needs and activities, which rated forty-two percent (42%) for mothers and forty percent (40%) for fathers. C. Service Planning and Provision Does the agency provide services to children and families to promote positive outcomes and improve child-well-being? Standards include facilitating the engagement of parents, involving case participants in the case planning process, and involving parents in the consent for psychotropic medication process.

Reviewers found in the ChildNet Side-by-Side cases no child was re-abused or re-neglected during the period under review (PUR). Service planning and provision follows assessment of needs. ChildNet received an eighty-six percent (86%) positive rating which represents twelve (12) of fourteen (14) applicable cases requiring service referrals. The two (2) cases determined to be not applicable for this standard already had service referrals in place prior to the PUR. For the two youth who needed services that were not provided, one youth required tutoring and the other youth was never assessed to even determine what services, if any, she needed after her case was reopened for a change of placement from one relative to another. A request for action was generated for the youth who needed tutoring, but no action was taken for the second youth because she had aged out prior to end of the review period.

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In addition to the initial and six-month assessments of the child and family situation, ongoing assessments are required. In the seven (7) cases where ongoing assessment found an immediate or emerging safety concern, intervention services were provided to protect the child and mitigate risk. The standard related to making concerted efforts to identify, locate and evaluate other potential relatives rated only fifty-five percent (55%) which represents six (6) of the eleven (11) children who were in out-of-home care during the PUR. Documentation reflects placement changes were planned in an effort to achieve the child’s case goals or to meet the need of the child in the two (2) cases where a child had more than two (2) placements during the PUR. However, the court was only notified in seventy-five percent (75%) of the cases where a child experienced any change in placement.

The frequency and quality of the documentation of thirty (30) day visits with the case participants both received ratings of eighty-eight percent (88%) but the frequency of on-going contacts with mothers and fathers remains an area needing improvement. Another standard considered as part of Service Planning and Provision pertains to the Independent Living/Teen Plan and assesses whether the teen-aged focus child is afforded an opportunity to participate in normal life skills activities that are reasonable and appropriate for his/her respective age or special needs. Data shows this is an area needing continued improvement. Seven (7) cases involved youth who were applicable to this standard and only two (2) of the seven (7) or twenty-nine percent (29%) had teen plans addressing normalcy. Of the youth who were between 15 and 18 years old, ChildNet appropriately monitored the youth’s progress towards successfully transitioning from foster care to independence through regular informative staffing for three (3) of five (5) applicable youths (sixty percent (60%). Of the two (2) youths without a staffing, one had recently entered out-of home licensed care and was due for a 15 ½ year old staffing and the other had a staffing that was slightly past the six (6) month required re-staffing. Services to address identified special educational needs and regular, periodic medical assessments are important to a child’s well-being. Review ratings indicate, where needs were identified, service follow-up did not always occur. There was parental consent or court order in the case management file for all 4 of the children prescribed psychotropic medications. Review findings indicate the case manager provided the prescribing physicians with the child’s pertinent medical information for three (3) of the four (4) applicable children prescribed during the PUR; the other was prescribed prior to the PUR. All four cases were appropriately documented in FSFN.

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D. Promoting Case Progress Does the agency conduct activities that facilitate achieving and maintaining permanency for children? Standards include appropriateness of the case plan stated activities and goal; stability of the child’s placement, exploration of Indian Child Welfare Act eligibility; compliance with Interstate Compact Procedures; and timely judicial reviews. DCF, ChildNet, Children’s Legal Services (CLS) and the court must work together to address the deficiencies related to the legal process noted. One area of utmost importance is the lack of current case plans (75% performance rating). Permanency is compromised when the family, case manager, CLS, and the court does not have a current case plan from which to assess progress on tasks and mitigation of risk. ChildNet’s rating for this measure declined from the previous year’s fourth quarter review finding of eighty-eight percent (88%). The appropriateness of the case plan goals has fluctuated for the 2nd, 3rd, & 4th quarters in FY 09-10 and continues this pattern as of the current review. Ratings of eighty-three percent (83%), one-hundred percent (100%), sixty-seven percent (67%), and seventy-five (75%) were determined during the respective reviews. The combined number of cases from last year’s quarterly and this year’s first semi-annual Side-by-Side review show that twenty-six of forty (26/40) cases, or only sixty-five percent (65%), had a current case plan. One way to achieve improvement in case plans is through timely follow-up to guidance and direction provided by supervisors. In the cases reviewed, supervisors often gave appropriate direction regarding the missing case plans; however, documentation of follow-up, by either the case manager or supervisor, was not always in the files. ChildNet, in conjunction with CLS (Attorney General’s Office [OAG] in Circuit 17) and the court system, may consider conducting a targeted review of all cases to determine which cases do not have current case plans, identify root causes as to why case plans expire without timely follow-up action and initiate remedial actions. In conjunction with this activity, reviewers should compare the goal, documented in FSFN, to the actual, current case goal and ensure accuracy and consistency. The current Side-by-Side review found that in four (4) of the sixteen (16) cases reviewed the goal was not the same as the one documented in FSFN when the sample was selected. If changes occurred to the permanency goals, FSFN did not reflect the updates. Accuracy in FSFN is critical for federal reporting, state and local planning and the allocation of resources. Reviewers disagreed with the appropriateness of the stated case plan goal of Another Planned Permanent Living Arrangement (APPLA) in three (3) cases. One (1) of the three (3) cases pertained to a thirteen (13) year old medically needy child residing in a facility. The agency plans to reunite this child with his mother after providing her with some medical training once she is released from incarceration. The other two (2) youths, ages fifteen (15) and sixteen (16)

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years of old, also did not meet the requirements in Chapter 39.6241, F.S. which provides the compelling reasons for exception to the APPLA goal. Statewide concerns have been raised regarding the use of the APPLA goal and Secretary Sheldon has recently issued a directive for review of all APPLA cases for appropriateness of the goal.

Case Plans can serve as a roadmap to help case managers gauge how well they are doing towards achieving permanency for each child. Several measures are taken into consideration when evaluating the effectiveness of ChildNet’s use of case plans in attaining the desired goal for each child. The current Side-by-Side review shows ChildNet had a current Case Plan in twelve (12) of the sixteen (16), or seventy-five percent (75%), of the cases reviewed. The following bulleted items reflect the ratings of the twelve (12) applicable cases for key case plan measures:

o Case plan addressed visitation with parents and siblings in care: one-hundred percent (100%)

o Case plan contained appropriate tasks for achieving permanency: one-hundred percent (100%)

Additional standards associated with the case plan include:

o Child’s placement was in close proximity to family: ninety percent (90%) o Focus child was placed with siblings who are in care: fifty percent (50%) o Documentation reflects, for a focus child who was not placed with siblings who are in

care, the separation was necessary to meet the child’s needs: one-hundred percent (100%)

Also impacting case planning and meeting legal requirements is the timely filing of Termination of Parental Rights (TPR) petitions or a documented court ruling finding extraordinary circumstances exist that support not pursuing TPR for children who have been in care 12 of the most recent twenty-two (22) months. The Office of the Attorney General (OAG) filed termination of parental rights (TPR) petitions in two of ten (2 of 10) or twenty percent (20%) of the applicable cases. Of the remaining eight (8) cases, only two (2) cases or twenty-five percent (25%) documented that the court found extraordinary circumstances for not filing a TPR petition. Case management and CLS need to work together to improve case record documentation of Judicial Reviews. Reviewers assessed whether Judicial Reviews occurred timely and if the case manager completed a thorough Judicial Review Social Study Report (JRSSR). Performance in the second, third and fourth quarters of 2009/2010 achieved ratings of eighty-eight percent (88%), sixty-three percent (63%), and fifty percent (50%) respectively. Results of the current review were ninety-four percent (94%). Reviewers observed, for the current Side-by-Side review the JRSSR reports were updated with relevant and pertinent information and hearings were held at least every six months.

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Supervisors need to address with service workers the need for on-going communication with service providers and obtaining copies of the service providers’ reports. Reviewers found the service workers’ communication with the service providers about the effectiveness of services for involved case participants occurred in only sixty-seven percent (67%) of the cases. The lack of obtaining pertinent, relevant information from service providers impacts safety and mitigation of risk, engagement of parents, quality of supervisory reviews and follow-up, the content and

quality of reports to the court and, ultimately, timeliness of achieving permanency. Reviewers found placement for eleven of the twelve (11 of 12) focus children in out-of-home care was stable and appropriate for meeting the child’s needs with no risks of disruption. The one youth not in a stable placement was on run-a-way status and reviewers found the required missing person’s procedure was implemented. ChildNet’s compliance with the Indian Child Welfare Act, based on Side-by-Side review findings for the past three (3) quarters (Q2, Q3, & Q4) of 2009-10, rated thirteen percent (13%), twenty-five percent (25%), and thirteen percent (13%) respectively. The ICWA rating for this review is twenty-seven percent (27%); depicting that this is still an area needing improvement. On-going efforts to comply with documentation requirements should result in improvement for this measure. There were no cases that required an Interstate Compact for the Placement of Children (ICPC) in this review.

E. Quality of Supervisory Reviews Direction and Follow-up (Are regular supervisory reviews being conducted timely and do they document that all aspects of the child’s safety, permanency and well-being were considered?) Standards include completion of timely quarterly case reviews; supervisory consideration of all aspects of child safety, permanency and well-being; and, follow through on guidance and direction.

Supervisors are required to provide face-to-face oversight to case managers quarterly on each case utilizing the Supervisory Quality Discussion Guide and documenting each face-to-face meeting in FSFN. It should be noted; ChildNet exceeds the statewide requirement of three (3) cases per service worker, per quarter, using the Discussion Guide because they require the guide be used for all supervisory reviews. In rating performance, reviewers considered the quarterly review, quality of the guidance provided and whether follow-up occurred. The reviews documented supervisors completed quarterly reviews in forty-four percent (44%) or seven of sixteen (7 of 16) cases. Reviewers

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observed, although supervisors did not complete their quarterly reviews timely, all but one (1) case had supervisory reviews documented some point during the period under review. The supervisors addressed all aspects of the child’s safety, permanency and well-being in eighty-eight percent (88%) of the cases. However, supervisors ensuring follow-up on the guidance and direction occurred in only 58% of the cases. It is important for supervisors to ‘close the loop.’ These directives often influence the direction, movement and timeliness of the case activities. The lack of follow-through often results in lower performance ratings in other standards for practice. Case reviews indicated the supervisors are using the statewide format for Supervisory Qualitative Discussions to document their quarterly reviews. Reviewers noted the practice of repeating the content of the formatted reviews each quarter and adding up-to-date information. Documentation of quarterly reviews may be limited to only those items pertinent to the current case status. It is noteworthy the statewide format is only a guide for the face-to-face discussion with the case manager. ChildNet’s Performance Quality Improvement (PQI) committee hosts monthly meetings during which a detailed review of their performance measures and results of their quarterly and/or semi-annual Base and Side-by-Side reviews are discussed in detail. The PQI committee meetings are attended by ChildNet staff from various divisions within their agency and the Department’s Regional Quality Assurance staff. Additionally, a PQI work group comprised of ChildNet staff generally meets weekly to develop tools for reporting performance to the Performance and Quality Improvement committee. Outcome measures from the Base and Side-by-Side reviews are addressed with ChildNet staff from various functional levels during the course of these processes. 4. In-Depth Review Findings

A. Findings from Case Specific Interviews The revised 2010 statewide Quality Assurance guidelines require interviews with participants from three Side-by-Side cases each review cycle. Interviewees should include the child, parents, caregivers, providers, advocates and Office of Attorney General (OAG) as applicable. The purpose of the in-depth interviews is to obtain a different perspective on service delivery and examine the case in more detail than file review provides. The in-depth interviews were conducted jointly with the team members from ChildNet and Regional QA who reviewed the respective case files. Variable criteria involving each individual case and the child’s goal served as the basis for selecting the interview cases. One case involved an in home Voluntary Protective Services case where the family was receiving services as a result of allegations of substance abuse, threatened harm. The second case involved an out-of-home protective services case of an infant who was removed from the mother at birth and placed in relative care with the maternal grandparents under court ordered protective

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supervision due to allegations of substance exposure. The third case was selected for a youth who had attained her goal of Independent Living and was now on Subsidized Independent Living. This youth refused to participate with the interview thus no further interviews were pursued on this case. The following two summaries provide information for the completed interview cases. Focus Child: A.M. The AM case involved a mother, father and a fifteen (15) month old girl. The family is currently under Voluntary Protective Services. The family came to the attention of the Department due to threatened harm allegations. The mother had a number of children removed from her care in the past and both parents have a history of substance abuse. The father is currently involved with Drug Court and the mother is prescribed pain medications for a physical condition. The child did not test positive for drugs at the time of birth. A legal staffing was held and a determination made there was no legal sufficiency to file Petition for Adjudication of Dependency. The family has been receiving voluntary services throughout the life of the case. In-depth interviews on this case were completed with the Child Advocate (ChildNet case manager), the mother and father. A telephone interview was scheduled with an in-home provider; however this interview did not occur due to last minute scheduling conflict. Interviews: Child Advocate: States she was assigned the case for approximately a year and is the only Child Advocate to work with the family. The family’s assessed needs were successfully matched with community services with no wait lists and the family is actively engaged in completing case plan tasks. The Child Advocate explained the mother is a stay-at-home mom and the father is a hard worker. The father uses his handyman skills to offset the apartment rent and also has a trust fund that is controlled by his adult sister. The family also receives food stamps and Medicaid benefits. The mother has numerous prescriptions for pain due to a variety of back/skeletal issues and has recently agreed to accept services through Susan B. Anthony to wean off the medications. These services are provided in the home. The father’s drug court involvement has now been extended due to a recent positive drug test. The family’s progress is monitored through regular contact with providers and the family is encouraged and supported to complete their tasks; there is no dependency court involvement at this time. The child’s safety is monitored through at least every thirty day visits (regularly unannounced). The parents are very cooperative and the child is thriving in their care. The case was initially staffed for legal sufficiency and was subsequently re-staffed with legal due to a request for action safety concern raised by the reviewers during the recent Side-by-Side case file review. In both instances where the case was staffed the assistant attorney general determined there was no legal sufficiency to file since the parents were cooperating with services. Biological Mother and Father: The parents were interviewed in their home with the child present. The child was observed to be clean, healthy and developmentally appropriate, demonstrating a good bond with both parents. They explained their involvement in the child welfare system was due to the mother’s past and she was “red-flagged” when the child was born. The parents both were familiar with the tasks required of them under their voluntary supervision agreement and had completed the majority of those tasks. They are/had been involved with Gulf Coast, Spectrum, Women in Distress (which mother felt inappropriate), drug

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court, a psychological evaluation, Work Force One and Susan B. Anthony. The father and mother discussed the recent abuse report openly due to the father testing positive for drugs. The only change they would wish to be made is to “shorten it” as it had been going on for a year. The parents confirmed the Child Advocate visits at least monthly; she checks the baby, takes her picture and checks if the family needs anything. They stated they could always get in touch with their Child Advocate and she responds to their calls and requests for assistance. Additional services for the family would involve help with transportation and diapers for the child. The parents expressed they have a support system in the community that consists of maternal and paternal relatives. Focus Child: JF The JF case involved a ten month old infant who was sheltered from the hospital at birth and placed under court ordered out-of-home care with the maternal grandparents. The child came into care due an allegation of substance exposed newborn. Although the infant’s test results were negative, the mother admitted to abusing substances during her pregnancy and initially opted to go for residential treatment. The father of the infant was not in a position to care for the child and therefore the baby was placed with the maternal grandparents following a background checks and a positive home study. The mother also has a six year old daughter who is being cared for by the maternal grandparents via a mutual agreement between the grandparents and the mother. In-Depth interviews on this case were completed with the assigned Child Advocate (CA), Guardian Ad Litem (GAL), and the maternal grandparents. The focus child and the six year old sibling were physically observed by reviewers when they visited the home. The Child Advocate was unsuccessful in obtaining interview appointments with either parent as both have been avoiding contact with the agency. Interviews: The Child Advocate (CA) stated she was assigned this case in December 2009 after a court order was obtained sheltering the child into the Protective Supervision of the DCF/ChildNet. The CA stated initially the mother agreed to enter rehabilitation and accepted services but, shortly after, told her mother she wasn’t ready to give up her life style and told the grandparents she wanted them to take care of the child. The CA stated she has made regular attempts to contact both the mother and the father using the address leads she can find, via certified mail, phone calls, and relaying messages through the maternal grandparents. She states she has had occasional contact with the mother by phone, but no success in reaching the father. The CA stated she still makes referrals and sends them via certified mail to addresses she has on file for either parent. She indicated she continues to conduct ongoing diligent searches. The CA states the grandparents provide excellent care for JF and his sister and at the last court hearing the judge changed the goal from reunification to adoption and a TPR petition is pending. The CA stated the sibling was not included in the case since the inception because she was not determined to be at risk. When asked about referrals for relative care, the CA stated the grandparents were not receiving relative caregiver funds but were financially able to care for the child. Originally, a face-to-face interview was scheduled with the GAL, but at the last minute the GAL telephoned to request the interview be conducted via phone instead. The GAL’s supervisor was

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also present with her via phone for the interview. The GAL stated she has been assigned to the child since August 2010. She stated she has visited with the child at home with his grandparents and sibling and the grandparents are taking very good care of JF. The GAL states she has never met either parent but, based on the case file, she agrees with the judge’s decision to change the goal to adoption The interview with the grandparents took place at their residence which was located in an upper middle class neighborhood in Fort Lauderdale. Upon entering the home it was spacious and clean with working utilities and adequate rooms for each child. The grandparents stated they own a non-profit business providing services to veterans and are financially able to care for the focus child. The focus child JF and his half-sister (who is not a party to the dependency case) were observed to be free of any marks or bruises indicative of abuse or neglect. Both children were also present during the interview and reviewers made small talk with the six year old sibling. Reviewers observed both children who appeared to be healthy and developmentally normal for their age. Reviewers also observed interactions between the grandparents and the children as well as the sibling with each other; they all appeared to be loving and appropriately affectionate towards each other. The grandparents held JF when he beckoned to get out of his high chair and appropriately directed the older child to play with her toys while they were being interviewed. The grandparents stated their daughter has had a problem with drugs since she was a teenager. They have been taking care of their six year old granddaughter since she was born because their daughter was not responsible. They stated they were not aware of their daughter’s second pregnancy with JF until after the baby was born. They stated when JF was born their daughter contacted them and told them about the baby; informing them of the Child Protective Investigation and requested they take the baby to prevent him from going into foster care while she entered a rehabilitation program. The grandparents agreed to care for the baby and the Child Protective Investigator conducted a home study and background check on them and their other adult daughter before they were able to bring the baby home from the hospital. The maternal aunt frequents the home and assists with caring for the children when the grandparents are away on short business trips; they also have a nanny who helps care for the children during the day while they are working. The grandparents state, although the mother initially agreed to enter a rehabilitation program, she later recanted and told the grandparents she wants the baby to remain in their care because she wasn’t ready to enter a treatment program and give up give up her life style. The grandparents further stated both parents have supervised visitation, but neither of them visits the child on a regular basis. The mother drops by occasionally and doesn’t spend anytime bonding with the baby and the father hasn’t visited since he and the mother broke up. They stated in the past they tried to help the father out by giving him a job in their company, but he wasn’t responsible and they had to let him go. They stated after the father stopped working for them the only contact they have had from him was by telephone when he called to ask the grandfather if he could borrow some money. The grandparents stated they attended the hearing in September 2010 and informed the judge about the parent’s non-compliance with visitation or other case plan tasks. They further expressed to the judged their concern about permanency for JF because neither parent was

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making any effort to viably work towards reunification. The maternal grandparents informed the judge they would like to adopt JF and provide him with a stable home and a secure future. As a result of the grandparents’ statements the judge ordered the goal changed to adoption. The grandparents informed the reviewers they would like to adopt both children but didn’t know if they had to do a private adoption for the six year since she is not included on the dependency case. Reviewers informed them to speak to the Child Advocate, GAL and OAG and inquire if it was possible to add the six year old sibling to the TPR petition. The grandparents stated they were comfortable with addressing their concerns with the parties and stated they had a good relationship with their Child Advocate and felt she has always been responsive to them. The grandparents further stated the Child Advocate visits JF monthly, sometimes more often, and felt the Child Advocate keeps them informed of all court hearings and staffing. B. System Assessment (if applicable) Regional Quality Assurance has not conducted any interviews of the systemic factors in Circuit 17 as of the writing of this report. A meeting was held with ChildNet and we have agreed upon one systemic factor that will be addressed later in the fiscal year. The logistics of whom and how we will proceed are being worked out. We will report the results of our systemic factor interviews in our 2010-11 second semi-annual review report. 5. Requests for Action

Reviewers submitted Request for Action (RFA) on 9 of the 16 cases. One RFA involved a safety concern regarding a Voluntary Protective Services case in which reviewers determined the mother’s prescription drug use may be affecting her ability to parent. ChildNet replied to the safety RFA indicating the concerns were addressed. This was also one of the cases selected for an in-depth interview and reviewers learned the mother arranged to enter Susan B. Anthony, a residential drug treatment program that houses mother and child/children. Some of the administrative RFAs pertained to missing documentation for the case files. Examples of missing documents included missing or expired case plans, untimely updates of family assessments and/ or supervisory reviews. Other administrative review items pertained to a lack of service referrals for identified needs and in some cases there was no documentation confirming well-being periodicity assessments for physical, educational, dental, or behavioral health assessments. Also a lack of documentation for verification of Indian Child Welfare Act (ICWA) eligibility was amongst the most common administrative concerns. All Requests for Action have been resolved. 6. Summary

ChildNet is working to improve services for youth, the quality of the areas of the CFSR systemic measures where they are under performing, and implement Trauma Informed Care and Family-Centered Practice. ChildNet is seeking accreditation through the Council on Accreditation (COA). As part of their COA process they have implemented Six-Sigma training for a cross section of their administrative and line staff so they will be better equipped to effectively and systematically identify and improve gaps in performance. Additionally, ChildNet has undergone a major restructuring of their “Client Services” department which included adding more front line case management units and Child Advocates. They believe this should result in more

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manageable case loads and more specialized attention given to each case. Their “Continuous Quality Improvement” (CQI) division works closely with “Client Services” and the “Training Division” to plan, coordinate, and implement strategies for ongoing improvement of their case management service delivery. The CQI division also holds monthly quality improvement meetings for administrative staff and other staff from Regional Quality Assurance. Additionally, ChildNet hosts a Performance Meeting quarterly where they present statistics on performance measures for their agency, Broward Sheriff’s Office-Child Protective Investigations (BSO-CPI), and Office of the Attorney General (OAG). Invitations to these quarterly meetings are sent to Regional/Circuit 17 DCF staff and other community stakeholders.

Based on the findings of the first Semi-Annual Side-by-Side, Regional Quality Assurance recommends improvement efforts focus on several areas that may result in the greatest improvement in performance ratings on the Quality of Practice Standards for Case Management: Establish a systematic process to identify and track due dates for Family Assessments

to insure all cases receive an initial and/or updated assessment at the inception and six-month intervals.

Hold supervisors accountable for not only conducting timely and qualitative Supervisory Reviews on all cases assigned to their units but also for ensuring follow-up on recommendations made.

Ensure concerted efforts are made to facilitate visitation (or other contact) between the child and the father.

Ensure concerted efforts are made to involve both parents in decisions related to their child.

Develop a tracking system to identify children who have been in out-of-home care for at least 12 of the most 22 months and ensure the timely filing of TPR petitions or document compelling reason for the exception in the case file when applicable.

Ensure teen age child/children receive Independent Living Assessments and Normalcy Plans.

Secure complete educational, medical, dental, and behavioral health assessments for each child in out-of-home care and document compliance in the case file.

Ensure medical and dental periodicity appointments are scheduled and maintain verification of compliance in the case file.

Implement a system to ensure Exit interviews are completed when required.

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Attachment I

Table 2: ChildNet, Inc Performance Ratings for 2010-11 First Semiannual Side-by-Side Review

ChildNet, Inc. - Date of Review: 10/11-15/2010 Total Total Count Question

# Question Y N NA %Yes

1.0 No child living in the home was abused or neglected. (applicable to in-home cases)

3 1 12 75% 16

2.0 The focus child was not abused or neglected. (applicable to out-of-home care cases)

13 0 3 100% 16

3.0 If a child was re-abused or re-neglected, immediate and ameliorative interventions were initiated on behalf of the child. (applicable to all cases)

1 0 15 100% 16

4.0

Concerted efforts were made to provide or arrange for appropriate services for the family to protect the child and prevent the child’s entry into out-of-home care. (applicable to in-home cases)

3 0 13 100% 16

5.0

A thorough initial family assessment was conducted following the investigative safety assessment that sufficiently addressed child safety factors and emerging risks. (applicable to all cases)

3 0 13 100% 16

5.0.1 Caregivers’ (if removed from)/parents’ capacity to protect and nurture the child;

3 0 13 100% 16

5.0.2 Observations of interactions between the child and siblings and household members;

2 1 13 67% 16

5.0.3 Emerging risk factors; 3 0 13 100% 16

5.0.4 Actions needed to address emerging risk factors; and 2 0 14 100% 16

5.0.5 Implementation of a safety plan when needed. 0 0 16 N/A 16

5.0.6 The initial family assessment was completed within 15 working days of ESI staffing / case transfer.

1 2 13 33% 16

6.0

Completed service referrals were consistent with the needs identified through investigative assessment(s), and other assessments related to safety. (applicable to all cases)

12 2 2 86% 16

7.0

The updated family assessment was focused on the immediate and prospective safety of the child, as well as any changes and implications in the family’s situation related to emerging concerns and service needs. (applicable to all cases)

9 5 2 64% 16

7.0.1 A review of changes in the family’s condition or circumstances since the initial assessment that positively or negatively impacted the child’s safety;

10 4 2 71% 16

7.0.2 A review of the short and long-term implication of any changes in individual or family factors affecting family resources, strengths and/or protective capacities;

9 5 2 64% 16

7.0.3 An evaluation of signs of emerging danger and a plan to address them;

8 5 3 62% 16

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7.0.4 A review of the case plan goals that were met and are remaining, and the plan to address any barriers that exist to fully meet the case plan goals.

9 5 2 64% 16

7.0.5 The family assessment was completed at least every six months and/or at critical changes in circumstances of the family unit.

4 10 2 29% 16

8.0 All immediate and emerging safety concerns were addressed and additional needed interventions were provided to protect the child. (applicable to all cases)

7 0 9 100% 16

9.0

A thorough safety assessment of the home was completed prior to reunification or placement of the child in an unlicensed out-of-home care setting. (Applies to cases involving post placement supervision, and where a child will be placed in an unlicensed [relative/non-relative] setting.)

2 0 14 100% 16

10.0

Concerted efforts were made during post-placement supervision to manage the risks following reunification and prevent re-entry into out-of-home care. (applicable to in-home post-reunification cases)

2 0 14 100% 16

11.0

The child remained safe in his/her home after being discharged from out-of-home care and did not re-enter out-of-home care at least 12 months following discharge. (applicable to out-of-home cases)

0 3 13 0% 16

12.0

A multi-disciplinary staffing/assessment for placement planning were conducted before each placement to ensure the placement or move was unavoidable. (applicable to out-of-home care cases)

3 1 12 75% 16

13.0

The child's current placement is stable and appropriate to meet the child's needs with no apparent or significant risks or projections of disruption. (applicable to out-of-home care cases)

11 1 4 92% 16

14.0

Concerted efforts were made to identify, locate and evaluate other potential relatives and possible permanent placements for the child. (applicable to out-of-home care cases)

6 5 5 55% 16

15.0 The child experienced no more than two out-of-home care placement settings during the period under review. (applicable to out-of-home care cases)

11 2 3 85% 16

16.0

If No was entered for #15, all placement changes were planned in an effort to achieve the child's case goals or to meet the needs of the child. (applicable to out-of-home care cases)

2 0 14 100% 16

17.0

In cases involving a child in a licensed placement setting, an exit interview was conducted with the child when moved from one placement to another, and appropriate action was taken if the exit interview documented a concern. (applicable to licensed out-of-home care cases)

0 2 14 0% 16

17.0.1 An exit interview was conducted with the child when he/she was moved from one placement to another to discuss the previous placement experience.

0 2 14 0% 16

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17.0.2 Appropriate action was taken if the exit interview documented a concern.

0 1 15 0% 16

18.0 The parents were notified of all the child’s placement changes. (applicable to out-of-home care cases)

2 2 12 50% 16

19.0 The court was informed of the child’s placements and reasons for changes in placement. (applicable to out-of-home care cases)

3 1 12 75% 16

19.0.1 Number and type of placement; and, 4 0 12 100% 16

19.0.2 Reason for the change in placement. 3 1 12 75% 16

20 Qualitative supervisory reviews and follow through were conducted as needed and required. (applicable to all cases)

9 7 0 56% 16

20.0.1 Reviews were completed quarterly. 7 9 0 44% 16

20.0.2 Supervisor considered all aspects of the child’s safety, well-being and permanency; and

14 2 0 88% 16

20.0.3 Supervisor ensured follow through on guidance and direction or documented the reasons the guidance and direction were no longer necessary.

9 7 0 56% 16

21.0 The case record contained a current (not expired) case plan. (applicable to court all cases)

12 4 0 75% 16

22.0 The current case plan goal was appropriate based on the child’s, and family’s circumstances. (applicable to all cases)

9 3 4 75% 16

23.0 The case plan specifically addressed visitation and other contact plans with all case participants. (applicable to out-of-home care cases)

7 0 9 100% 16

23.0.1 Mother 7 0 9 100% 16

23.0.2 Father 3 0 13 100% 16

23.0.3 Caregiver (removed from) 0 2 14 0% 16

23.0.4 Between siblings 1 0 15 100% 16

24.0

The case plan is designed to achieve permanency (out-of-home care cases) and safety and stability (in-home cases) through appropriate tasks for the case participants.

10 0 6 100% 16

24.0.1 Mother 10 0 6 100% 16

24.0.2 Father 5 0 11 100% 16

24.0.3 Child (if developmentally or age appropriate) 4 0 12 100% 16

24.0.4 Caregiver (removed from) 0 2 14 0% 16

25.0 The services worker communicated with service providers about the effectiveness of services for involved case participants. (applicable to all cases)

10 5 1 67% 16

25.0.1 Mother 9 2 5 82% 16

25.0.2 Father 5 1 10 83% 16

25.0.3 Child 8 3 5 73% 16

25.0.4 Out of Home Care Provider (includes relative / non-relative)

4 1 11 80% 16

26.0

The child’s current placement was in close proximity to the parents to facilitate face-to-face contact between the child and parents while the child was in out-of-home care. (applicable to out-of-home care cases)

9 1 6 90% 16

26.0.1 Mother 9 1 6 90% 16

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26.0.2 Father 3 0 13 100% 16

27.0

If No was entered for #26, the location of the child’s current placement was based on the child’s needs and achieving the case plan goal. (applicable to out-of-home care cases)

1 0 15 100% 16

28.0 The child was placed with siblings who were also in licensed and/or non-licensed out-of-home care. (applicable to out-of-home care cases)

3 3 10 50% 16

29.0 If No was entered for #28, there was clear evidence separation was necessary to meet the child’s needs. (applicable to out-of-home care cases)

3 0 13 100% 16

30.0

Concerted efforts were made to ensure visitation (or other contact) between the child and parents were sufficient to maintain or promote the continuity of the relationship between them. (applicable to out-of-home care cases)

8 3 5 73% 16

30.0.1 Mother 8 3 5 73% 16

30.0.2 Father 2 3 11 40% 16

31.0

Concerted efforts were made to ensure visitation (or other forms of contact if visitation was not possible) between the child and his or her siblings and it was of sufficient frequency to maintain or promote the continuity of the relationship. (applicable to out-of-home care cases)

2 1 13 67% 16

32.0 Concerted efforts were made to maintain the child’s important connections. (applicable to out-of-home care cases)

12 0 4 100% 16

33.0

An inquiry was made to determine if the child was of Native American or Alaskan Native heritage. (Life of Case - applicable to out-of-home care and court ordered supervision cases)

4 11 1 27% 16

34.0

If the child is of Native American or Alaskan Native heritage, the tribe was provided timely notification of its right to intervene in any state court proceedings seeking court ordered supervision, an involuntary out-of-home care placement or termination of parental rights. (applicable to out-of-home care and court ordered supervision cases)

0 0 16 N/A 16

35.0

Concerted efforts were made to place the child in out-of-home care in accordance with the Indian Child Welfare Act placement preferences if the child was of Native American or Alaskan Native heritage. (Life of Case - applicable to out-of-home care cases)

0 0 16 N/A 16

36.0 The mother was encouraged and supported to participate in making decisions about her child’s needs and activities.

5 7 4 42% 16

37.0 The father was encouraged and supported to participate in making decisions about his child’s needs and activities.

2 3 11 40% 16

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38.0

For cases in which an out-of-state placement was, or is being, explored for the focus child, a complete Interstate Compact for the Placement of Children (ICPC) packet requesting a home study was submitted within the required timeframe. (applicable to out-of-home care cases)

0 0 16 N/A 16

39.0

The information provided in the ICPC packet regarding the focus child was sufficient to enable the receiving state to make an appropriate decision concerning approval of the proposed placement for the focus child. (applicable to out-of-home care cases)

0 0 16 N/A 16

40.0

If the child was in out-of-home care for at least 12 of the most recent 22 months or met other ASFA criteria for TPR, a TPR petition was filed or joined. (applicable to out-of-home care cases) Life of Case

2 8 6 20% 16

41.0

If a Termination of Parental Rights petition was not filed, there were compelling reasons and an exception for not filing the petition was documented. (applicable to out-of-home cases)

2 6 8 25% 16

42.0 Appropriate steps were taken to identify and recruit an adoptive family that matched the child’s needs. (applicable to out-of-home care cases)

3 0 13 100% 16

42.0.1 if TPR has occurred, then have appropriate steps been taken to identify and recruit an adoptive family;

1 0 15 100% 16

42.0.2 If TPR has not occurred; then is there evidence of recruitment efforts being initiated.

2 0 14 100% 16

43.0 Appropriate steps were taken to process and approve an adoptive family that matched the child’s needs. (applicable to out-of-home care cases)

2 0 14 100% 16

44.0

If the case involves a youth who has reached 13 but not yet 15 years of age and he/she is living in a licensed, out-of-home care placement, a pre-independent living assessment was completed that identified service needs and services were provided. (applicable to licensed out-of-home care cases)

0 2 14 0% 16

45.0

If the child is 13 years of age or older and in licensed foster care, the case management agency provided guidance and assistance in developing an educational and career path that is based on the child's individual abilities and interests. (applicable to licensed out-of-home care cases)

3 4 9 43% 16

46.0

The teen-aged focus child is afforded opportunities to participate in normal life skills activities in the foster home and community that are reasonable and appropriate for his/her respective age or special needs. (applicable to licensed out-of-home care cases)

2 5 9 29% 16

47.0

For youth 15 years of age but not yet 18, the agency appropriately monitored his/her progress towards successfully transitioning from foster care to independence through regular informative staffing.

3 2 11 60% 16

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48.0 An ongoing assessment of the child(ren)’s needs was conducted to provide updated information for case planning purposes. (applicable to all cases)

12 4 0 75% 16

49.0 An assessment for residential group care was completed when required. (applicable to out-of-home care cases)

3 0 13 100% 16

50.0 An ongoing assessment of the mother’s needs was conducted to provide updated information for case planning purposes. (applicable to all cases)

11 4 1 73% 16

51.0 Concerted efforts were made to support the mother’s engagement with services. (applicable to all cases)

10 4 2 71% 16

52.0 An ongoing assessment of the father’s needs was conducted to provide updated information for case planning purposes. (applicable to all cases)

6 2 8 75% 16

53.0 Concerted efforts were made to support the father’s engagement in services. (applicable to all cases)

6 2 8 75% 16

54.0

An ongoing assessment of the out-of-home care providers or pre-adoptive parent's service needs was conducted in order to ensure appropriate care for the child. (applicable to out-of-home care cases)

6 3 7 67% 16

55.0 Concerted efforts were made to actively involve all case participants in the case planning process: (applicable to all cases)

12 4 0 75% 16

55.0.1 Mother 10 4 2 71% 16

55.0.2 Father 6 3 7 67% 16

55.0.3 Child (if developmentally or age appropriate) 7 1 8 88% 16

55.0.4 Out of Home Care Providers 9 2 5 82% 16

56.0

The frequency of the services worker's visits with all case participants was sufficient to address issues pertaining to the safety, permanency goal, and well-being of the child. (applicable to all cases)

14 2 0 88% 16

56.0.1 Mother 7 5 4 58% 16

56.0.2 Father 4 2 10 67% 16

56.0.3 Child 15 1 0 94% 16

56.0.4 Caregiver (out-of-home) 11 1 4 92% 16

57.0

The quality of the services worker’s visits with case participants was sufficient to address issues pertaining to the child’s safety, permanency and well-being. (applicable to all cases)

14 2 0 88% 16

57.0.1 Mother 11 1 4 92% 16

57.0.2 Father 5 1 10 83% 16

57.0.3 Child 15 1 0 94% 16

57.0.4 Caregiver (out-of-home) 11 1 4 92% 16

58.0

Concerted efforts were made to assess the child’s educational needs during out-of-home placement. (applicable to out-of-home care cases and in-home cases if relevant)

8 3 5 73% 16

59.0 If educational needs were identified, necessary educational services were engaged. (applicable to out-of-home care cases and in-home cases if relevant)

4 3 9 57% 16

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60.0 Services effectively reduced or resolved the issues that interfered with the child’s education. (applicable to out-of-home care cases and in-home cases if relevant)

4 2 10 67% 16

61.0

Concerted efforts were made to assess the child’s physical health care needs. (Applies to all out-of-home care cases. Applies to in-home cases when relevant to why the child and family are involved with the dependency system)

8 5 3 62% 16

61.01

If the child was removed during the period under review, or if not removed but brought into the into the dependency system due to health related issues, he/she received a medical screening within 72 hours.

2 1 13 67% 16

61.02

After the removal episode or health issues that resulted in interventions by the dependency system, and the medical screening were not done within 72 hours, a medical screening was completed within a week.

0 1 15 0% 16

61.03 Documentation reflects that the services agency complied with the periodicity schedule pertinent to the child’s age and needs.

7 5 4 58% 16

62.0

Concerted efforts were made to provide appropriate services to address the child’s identified physical health needs. (Applicable to out-of-home care cases and in-home cases if relevant to the reason the agency is involved.)

1 2 13 33% 16

62.01 The diagnoses from physical health care screenings are documented in the case file.

1 2 13 33% 16

62.02 Documentation reflects that the services agency followed-up on treatment plans that the doctor ordered.

1 1 14 50% 16

63.0 Concerted efforts were made to assess the child’s dental health care needs. (applicable to out-of-home care cases and in-home cases if relevant)

2 9 5 18% 16

63.01 Documentation reflects that the child's dental health care needs were assessed.

3 8 5 27% 16

63.02 Documentation reflects that the services agency complied with the periodicity schedule pertinent to the child’s age and needs.

2 9 5 18% 16

64.0 Appropriate services were provided to address the child’s identified dental health needs. (applicable to out-of-home care cases and in-home cases if relevant)

0 2 14 0% 16

65.0 An assessment(s) of the child’s mental/behavioral health needs was conducted. (applicable to out-of-home care cases and in-home cases if relevant)

8 4 4 67% 16

66.0 Appropriate services were provided to address the child’s mental/behavioral health needs. (applicable to out-of-home care cases and in-home cases if relevant)

6 2 8 75% 16

66.01 Documentation reflects that the services agency matched the needed services specific to the child’s mental/behavioral concerns.

6 2 8 75% 16

66.02 Documentation reflects that the services agency followed-up on all treatment plans that the doctor ordered.

6 0 10 100% 16

67.0

Express and Informed consent or court authorization was obtained for the use of each psychotropic medication deemed necessary by a physician to address the child’s mental/behavioral health needs. (applicable to out-of-home care cases)

4 0 12 100% 16

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67.0.1

The case management organization involved the child and the parents/legal guardian in the decision making process by facilitating contacts with physicians for treatment planning.

3

0

13

100%

16

67.0.2

Prior to seeking a medical evaluation to determine the need to initiate or continue a psychotropic medication, the case manager provided the Prescribing Physician all pertinent medical information known to the agency at the time.

3 0 13 100% 16

67.0.3

The case manager documented communication with the child's parent or guardian to ensure parental awareness of the need to provide express and informed consent for the prescription of each psychotropic medication.

3 0 13 100% 16

67.0.4

When express and informed consent could not be obtained from the child's parents, the case management organization submitted a request for court authorization to Children's Legal Services.

3 0 13 100% 16

67.0.5 When there was a need for a court order, one was obtained.

3 0 13 100% 16

68.0

All data fields in the Florida Safe Families Network related to psychotropic medications appropriately and accurately documented the child's prescribed medications (applies to out-of-home care cases).

4 0 12 100% 16

68.0.1 Name of medication and dosages prescribed 4 0 12 100% 16

68.0.2 If medication is for psychotropic purposes 4 0 12 100% 16

68.0.3 Prescription begin and end dates 4 0 12 100% 16

68.0.4 Dates of expressed and informed parental consent or court order

4 0 12 100% 16

68.0.5 Name of prescribing physician 4 0 12 100% 16

68.0.6 Reason the medication was prescribed 4 0 12 100% 16

69.0

Judicial Reviews were held in a timely manner and Judicial Review Social Study Report's (JRSSR's) provided a thorough investigation and social study concerning all pertinent details relating to the child.

15 1 0 94% 16

This item is not included in the total score Response Response Response Response Response

70.0

Based on all the information reviewed, it is likely that the child will live in a safe and nurturing environment with his/her needs being met on a permanent basis during the next 12 months.

12 3 1 80% 16

71.0

For children with the goal of "Another Planned Permanent Living Arrangement" (APPLA), the agency made concerted efforts to provide the needed service that would adequately prepare the child for transition to adulthood. (applicable to APPLA cases)

3 2 11 60% 16

71.0.1

The agency has made or is making concerted efforts to adequately prepare the child to transition from foster care into independent living upon being emancipated or reaching the age of majority.

4 1 11 80% 16

71.0.2 The living arrangement is deemed "permanent" based on a commitment on the part of the foster parent, relative or non-relative caregiver.

3 2 11 60% 16

Quality Assurance 

Side by Side Review 

First Semi‐Annual FY 2010‐2011 

ChildNet, Inc. 

28 

 

71.0.3 The child is in a long-term facility and will remain in that facility until transition into an adult care facility.

1 2 13 33% 16

Safety Outcome Total YES 55

Safety Outcome Total NO 8

Safety Outcome Total NA 97

Safety Outcome Total % YES 87%

Permanency Outcome Total YES 108

Permanency Outcome Total NO 65

Permanency Outcome Total NA 291

Permanency Outcome Total % YES 62%

Federal Child & Family Services Review Total YES 43

Federal Child & Family Services Review Total NO 12

Federal Child & Family Services Review Total NA 9

Federal Child & Family Services Review Total % YES 78%

Well-Being Total YES 171

Well-Being Total NO 77

Well-Being Total NA 184

Well-Being Total % YES 69%

Overall Total YES 377

Overall Total NO 162

Overall Total NA 581

Overall % of YES Responses 70%