DHS officials outline ambitious plan to reform state's child welfare system | Arkansas Blog

Tuesday, November 15, 2016

DHS officials outline ambitious plan to reform state's child welfare system

Posted By on Tue, Nov 15, 2016 at 1:49 PM

click to enlarge MISCHA MARTIN: The DCFS director acknowledged problems within the agency. - BRIAN CHILSON
  • BRIAN CHILSON
  • MISCHA MARTIN: The DCFS director acknowledged problems within the agency.

On Monday morning, top staff at the Arkansas’ Department of Human Services (DHS) and its Division of Children and Family Services (DCFS) announced the results of a four-month strategizing mission to fix what they called a child welfare system in crisis.

The first phase of the DCFS improvement plan is ambitious and substantial. By putting more resources into “in-home services,” the agency wants to decrease unnecessary removals of children from their families. It aims to add 228 new staff statewide and address its chronic staff turnover problem. It plans to place more children with their relatives, rather than the broader foster care system. It hopes to streamline the foster parent application process. And it aims to stop the inappropriate placement of some children in behavioral health facilities.

Coupled with Governor Asa Hutchinson’s announcement last week of a $39 million boost in DCFS funding over the next two years — among the largest proposed increases in the fiscally conservative governor’s budget — the DHS plan represents a concerted, sustained effort to improve child welfare outcomes in Arkansas.

Since the beginning of 2015, Arkansas has seen a 30 percent increase in the number of children in foster care, fewer children exiting foster care, and a beleaguered field staff with such high turnover that most field social workers in DCFS now have just an average 1.8 years of experience on the job.

Since the first week of May, DCFS administrators, officials from other DHS divisions, partners with local and national nonprofits and Medicaid experts have been meeting several times a week for “war room” sessions intended to figure out what was going wrong in the state’s child welfare system and how it could be stabilized.

“There are so many issues going on, and they feed on each other,” said DHS Director Cindy Gillespie. “What we’re focused on is breaking that cycle.”

Last month, the Arkansas Times obtained an internal report prepared for DCFS by consultant group Hornby Zeller Associates, Inc. (HZA) that identified a number of issues contributing to the sharp rise in the foster care population since Jan. 2015. Crucially, HZA said child abuse and neglect incidents did not substantially increase over that time period. The report, which was delivered to DCFS in June, found that there had been a notable increase in “questionable removals” of children from their homes. Of 400 sample cases HZA examined, 22 percent of children who’d been taken into foster care perhaps should have been left with their families, the consultant said. The report attributed the problem largely to internal divisions within DCFS, as well as the role of local courts, which are sometimes hostile to the idea of leaving children at home or with relatives.

In October, DCFS Director Mischa Martin said the consultant’s report showed a limited picture of what was happening, and that the agency was working on its own, more comprehensive assessment of the problem, as well as its possible solutions. That report, “Moving Beyond Crisis,” was released yesterday and was presented by Gillespie and Martin as the first phase of a long-term plan to stabilize and improve the child welfare system. A distillation of the “war room” sessions, the report acknowledged that with 5,200 children in foster care — a roughly 1,200-child increase from 2014 — the system is failing, lacking both “the right placement options for abused and neglected children and adequate prevention programs to help struggling families.”

“Aside from the unprecedented growth, the problems discussed in the war room meetings are not new,” the report said, “but the approaches identified to address them are new to Arkansas. These solutions are the result of having many partners — not just child welfare experts — at the table.”

click to enlarge CINDY GILLESPIE: The DHS director acknowledged the child welfare system is in a state of crisis. - BRIAN CHILSON
  • BRIAN CHILSON
  • CINDY GILLESPIE: The DHS director acknowledged the child welfare system is in a state of crisis.

The specific goals of the stabilization team included a renewed focus on strengthening families so children can remain safely at home; improving foster care through a stronger DCFS workforce and community partnerships; and, better policies for children in need of behavioral health treatment and families in need of help with substance abuse. DCFS Director Martin said the agency’s work fell into three buckets:

1. Helping keep children at home

In recognition of the fact that children generally fare better and are less traumatized by remaining with their families, the report focused heavily on ways to preserve families. At the end of fiscal year 2016, more than 6,000 children were being monitored through what DCFS calls “in-home cases.” But high caseloads and an overburdened DCFS field staff means that caseworkers are unable to keep up with the demand to visit homes and provide support services.

This could partly be addressed through a new prevention and reintegration unit, if Gov. Hutchinson’s $26.7 million proposed budget increase wins legislative approval. DHS is also seeking to create a supplemental home visiting program — entirely funded by federal Medicaid dollars — to provide oversight for families with children under eight who have had substantiated reports of neglect, failure to thrive, Garrett’s law (children born with illegal drugs in their system), medical neglect or Munchausen Syndrome. The new program would coach families on basic parenting, home and financial issues and provide guidance and practical support, such as transportation assistance, to help parents manage children’s medical care.

At present, said Gillespie, the agency lacks the means of effectively helping keep children at home in situations where it may be safe to do so. “We can’t get the family ready to take a child back,” she said. “That’s why [Director Martin’s] first bucket, the Prevention and Reintegration Unit, is an incredibly important part of what we’re doing. We haven’t got the resources, in or out of house, to focus on a family that might be getting into trouble.”

2. Improving placement options

The report also emphasized DCFS’s aspiration to improve the quality of placements for children who do need to be in foster care. In a system where most foster children move between multiple placements, and sometimes more than a dozen homes, the report said the agency wants to focus now on creating stability and preventing transfer trauma by getting “the first placement right.” Currently, more than half of all foster children are placed outside their home counties because there isn’t a local home available. Through a modest increase in its total foster homes — an added 108 regular foster homes and an additional 56 therapeutic foster homes — the agency hopes to keep 55 percent of foster children within their counties of origin by next August. (The Arkansas Times wrote about the developing placement crisis in Arkansas foster care in July 2015.)

The report also focused on the need to increase the number of children who are placed with extended family, rather than the wider foster home system. This was a particularly important recommendation of consultant Paul Vincent in 2015, who noted, “a crucial place to look for solutions to the placement challenge is the use of relative placements and guardianships.”

We've written before of relatives who say they were desperate to take children into their homes but were shut out of the process by the child welfare system. The national average for such placements is 29 percent, but Arkansas has long lagged behind, with just 21.3 percent of children placed with family (or “fictive kin”) as of this May. Some of that is due to reasons beyond DCFS control, such as juvenile judges who refuse to leave children with family members of neglectful or abusive parents. But DCFS’ report also found a number of internal reasons, including significant bureaucratic hurdles and staffing shortages. Since this summer, the agency has attempted to address these by decentralizing some approval processes, liaising with local law enforcement to run background checks, and having workers on call to approve homes after hours. With these improvements, the number of relative placements has now risen to more than 25 percent, and the agency aims to reach or exceed the national average by next August.

We've also written of the backlog of foster parent applications, and of complaints from potential and current foster families who say the application process is counterintuitive and arduous. DCFS says it is working to streamline the foster parent application process more generally, to take a more customer service-based approach to interactions with families, and to modernize its methods of communication. For example, it is initiating a text messaging system for caseworkers seeking placement options for new foster children. And it is piloting a “Rapid Response” program in Sebastian County — which has long exemplified the state’s foster care crisis, with reports last year of foster children having to sleep in DCFS offices — that could fast track permanency plans for children whose adoption or family reunification plans have stalled.

A basic problem underlying all of these efforts is how overworked DCFS’s staff is — a fact the Arkansas Times has reported on before. Despite the sharp rise in children in the foster care system, DCFS’s total staff numbers have not increased accordingly (and after 2010, were depleted by staffing cuts). The result is that Arkansas family service workers handle, on average, nearly twice as many cases as the national standard, leading to an average of 240 annual overtime hours per employee. Agency wide, in fiscal year 2016, the agency paid $3.1 million for almost 208,000 overtime hours.

Predictably, the burnout rate is high. Most of the agency’s geographic service areas have a 32 percent turnover rate for family service workers, leading to a dearth of experienced staff and a surfeit of inexperienced workers making decisions about cases.

While everyone knows turnover rates in the agency are high, said DHS Director Gillespie, “the reports we get are that every month the experience [level] of our staff is going down. … A big piece of focusing on this area is not just ‘let’s add more bodies,’ but how do we address retention? What is making them leave us?”

For staff working such a huge amount of overtime, Gillespie continued, their lives effectively belong to their jobs.  “We hear from workers that they’d be willing to take a reduction in overtime to avoid burnout,” said Martin. “At some point you can’t function when you’re working 24/7 all the time.”

Gov. Hutchinson’s request for funding would create 228 new DCFS jobs, including 150 new family service workers, 18 supervisors and 60 program assistants. Among that number would be five staffers who make up a “mobile crisis unit,” which could deploy to areas that have lost staff, to fill in the gap until new staff are hired. DCFS is also hopeful that a new pay plan for agency staff could further enable them to recruit and retain staff.

click to enlarge BEHAVIORAL HEALTH IS KEY: Dr. Charlie Green, Director of DHS' Division of Behavioral Health, and Assistant Director Paula Stone. - BRIAN CHILSON
  • BRIAN CHILSON
  • BEHAVIORAL HEALTH IS KEY: Dr. Charlie Green, Director of DHS' Division of Behavioral Health, and Assistant Director Paula Stone.

3. Better behavioral health care


Another problem DCFS identified was a number of foster children who have lingered in behavioral health facilities beyond any medical necessity, simply because the agency lacks the means to transition them back into the community. That creates worse scenarios for children and great expense to the system.

Starting next July, the agency hopes that it will be able to offer more comprehensive support services to limit children’s time in institutions, but in the interim it has requested Medicaid funding to create immediate transition services for children to exit unnecessary psychiatric care. Among other things, this federally funded initiative will develop a mobile assessment and crisis mobilization unit that the agency hopes will be operational this month.

Going forward, said DCFS Director Martin, the “war room” strategizing sessions will transition into a series of monthly reports, tracking the progress of the multiple initiatives that the agency is putting into place, with the goal of reaching stability within a year. Still, DHS Director Gillespie warned, the issues facing the system are complex and will require multiple simultaneous solutions.

“There is no magic bullet that fixes all of this," she said.

Benjamin Hardy contributed to this report.

Funding for this reporting was provided by people who donated to a crowdfunding campaign on ioby.com and the Arkansas Public Policy Panel.

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