Los Angeles County Grand Jury
2011-2012
From the annual report
The consolidated year-end volume. The individual investigations it contains are listed separately below.
📑 Year-End Report
The full consolidated volume; individual reports are listed below.
Individual reports (33)
Findings & Recommendations
8 findings
F1:
Most charter cities expended more than they received in revenues - (1) the City's expenditures exceeded revenues primarily due to Capital Outlay/Projects, which were funded through the accumulation of The City of Whittier believe this finding is an of financial health for Whittier, the City ~tt.::>rnntc! to fund Projects without the use financing.
F2:
Most total net fund balances declined in 10, and ',,,'n!',",,,,,, cities had ratios of to total liabilities lower than (1) Grand Jury the City of Whittier's Net actually increased and in Fund Balance is related the use of assets for construction of capital assets. In this Fund was used for the Construction of a New Police Station. Governance in providing strategic focus and direction to ) The City of Whittier a mission statement defining direction for In addition, City Adopted Workplan to current focus and direction for 1 City Whittier Responses to 2011-12 CGJ Final Report
F3:
Most could improve and maintenance and procedures - (1) City believes policies documented, but may find benefit to standardizing Most charter could improve policies procedures for reporting fraud, abuse and questionable practices - (1) The City has an Ethics (Fraud) Policy in place and it provides appropriate information and mechanisms reporting concerns.
F4:
Policies and procedures for documenting compliance with procurement requirements and providing contract compliance and oversight could be improved to eliminate dealing with same parties. - (1) while there may be some truth to the fact that policies and procedures could be improved, there may not be a direct connection to eliminating dealings with same parties. Whittier currently has various levels of purchasing requirements based on the transaction amount. City of Whittier Responses to 2011-12 CGJ Final Report
F5:
All but one city adopted a Conflict Code - (1) City of Whittier Conflict of Interest >:>f'1,..... n1r0f'1
F6:
All they had an Investment Policy - (1) City of an adopted Investment Policy. Financial Management Practices
F7:
Many charter cities' policies and procedures governing General Fund Unrestricted Fund Balance could be improved - (1) Whittier's unrestricted General Fund Balance is reported and updated to City Council several times annually, and appropriation of funds must be approved by City Council.
F8:
All charter cities maintained adequate financial system and financial statements - (1) Whittier maintains a modern financial information system and audited financial information is formally presented to Council, submitted to appropriate regulatory agencies and posted on the City's website. Procurement & Contracting Practices
Additional Recommendations
22
Not linked to specific findings.
R1:
O. The City agrees with the recommendation. Article XXXIV, 1 of the City's Charter calls for Council to employ a public accountant or firm of public accountants to perform audits. An independent audit firm was used for FY201 1 audit reports that were prepared completed on time. were presented to Council on July 31, 201 n::>n,nrrC! 11. Charter cities should review and update accounting policies and procedures to ensure they are appropriately detailed and define the specific authority and responsibility of employees. Cities should also establish a policy requiring policies and procedures to be annually updated least once every years. 1. The recommendation has implemented. On April 24, 2012 City adopted by resolution updating the internal control policies as part of City's Standard Operating Procedures address financial procedures information technology. Charter cities should and update policies and procedures for rep.OI~ting· fraud, abuse and questionable practices including a piactical mechanism, such as a fraud hotline, to permit the confidential, anonymous reporting of concerns.
R2:
The agrees with the recommendation. The City's Financial policy #3 states that, "It is the policy the City Inglewood to fund current expenditures for operating budgets with current revenues." 3. All Charter cities reviewed in this report should commit to not using one time revenues to fund recurring or on-going expenditures. City with the recommendation. The City's Financial Policies, policy#12 that, "It shall be the policy of the City of Inglewood to not use one-time revenues for on-going expenditures. One W Manchester Boulevard· Inglewood, CA • 90301 • Phone (310) 412-5301 • Fax (310) 412-8788 • 4. All Charter reviewed this report should adopt multi-year budgets for better planning to ensure the delivery of basic before funding projects of lower priority.
R3:
in this report should to not using revenues to fund or on-going expenditures. City Torrance concurs with
R4:
The City agrees with the recommendation. City Manager is considering development of a multi-year budget within next two years. In addition, the City Inglewood adopted a 5 Year Capital Improvement Plan (CIP) provides for multi-year budgets for better planning and preparation of future for funding projects of lower priority. 5. All Charter reviewed in this report should adopt a method and practice of saving into a reserve or "rainy day" fund to be used to supplement operating revenue in years of short fall.
R5:
agrees with the recommendation. City's Financial Policies, policy requires City establish and maintain at a reserve fund for the Fund equal to 8% of current expenditure appropriation and adequate operating reserves for all other funds. Prior to the recession, method and practice saving into reserves for a "rainy day" for future operations was practiced. 6. Charter cities should develop and adopt a strategic plan that articulates the mission, vision, core values and priorities (goa and objectives) for the City.
R6:
City with the recommendation. City will to its miSSion, and priorities in budget document the upcoming FY 2013 2014 budget preparation process. Charter cities should develop and report on performance measures or indicators to evaluate outcomes or progress on priorities. These performance measures should be quantified, focused on outcomes or results, and information should be provided for several years to allow evaluation of progress over time. City with the recommendation. The City is currently developing data and implementing processes for reporting performance measures to the outcomes and progress the operating departments in the FY2013-2014 Charter city councils should continue to maintain a governance policy that specifically defines the relationship between the council and executive. Charter city councils should continue providing specific annual goals for the city's executive (City Manager of City Administrator) and conduct meaningful evaluations annually. City with the recommendation, but presently maintains current system which of the City Council providing constant feedback and 2 direction to the City Manager while goals and monitoring as a its overall ongoing oversight responsibility of the city manager. 9. Charter cities should formally establish an audit committee making it directly responsible for the work of the independent auditor. City agrees with the recommendation but it has not implemented. The Department is responsible for the work performed by the selected auditing firm and currently does not have an audit committee. 10. All charter cities reviewed in this report should continue requiring compliance with standards independence for the auditor. Cities that not currently the auditor through a competitive process should, do ' "Cities that allow the auditor to provide non-audit services should ensure appropriate review and approval of those services.
R7:
Charter cities should develop report on measures or indicators to outcomes or progress on priorities. performance measures should be quantified, focused on outcomes or and information be provided for years to allow evaluation ofprogress over time. following cities should develop such performance measures for indicators: Arcadia, Bell, Compton, Industry, Inglewood, Lancaster, City. Agree - 2005, the had a performance indicators program, which was restructured in 2012 and are reported quarterly to the CounciL
R8:
city councils continue to a governance policy that the relationship between council and executive. Charter councils should continue providing annual goals for city's (City Manager or City Administrator) conduct meaningful evaluations annually. Thefollowing should do so: Alhlll11bra, Bell, Industry, Inglewood, Agree annual evaluation are conducted by the TTA·....."'." Council.
R9:
cities should establish an audit committee making it directly responsible for work ofthe independent auditor. following cities should formally establish an audit committee: Alhambra, Arcadia, Bell, Cerritos, Compton, Industry, Inglewood, Irwindale, Pomona, Santa Monica, Hill, Temple Whittier. had an audit to the Brown which vv"u.u.U meets six 1O. All charter reviewed in this report should continue requiring compliance with standards of independence for external auditor. that do not currently select the auditor competitive should do so. that allow auditor to provide non-audit ensure aplprCIPflla approval of those City an RFP process, to an independent external auditor on a basis. the RFP are reviewed and accepted by the audit and subsequently presented and adopted the City CounciL external auditors reviewed the City's security protocols as a non-audit which were reviewed
R10:
All charter cities reviewed in this report should continue requiring compliance with standards independence for the auditor. Cities that not currently the auditor through a competitive process should, do ' "Cities that allow the auditor to provide non-audit services should ensure appropriate review and approval of those services. R1 O. The City agrees with the recommendation. Article XXXIV, 1 of the City's Charter calls for Council to employ a public accountant or firm of public accountants to perform audits. An independent audit firm was used for FY201 1 audit reports that were prepared completed on time. were presented to Council on July 31, 201 n::>n,nrrC!
R11:
cities should rf-""f1""M "1-''-'''''''''' accounting policies and Drc)ce,our to ensure they are detailed specific authority and employees. Cities should rp",nA""" establish a policy and procedures to be n",,,,,...,,,,,...,, annually and updated at once every three years. should review and policies and ............r-, at least once every Alhambra, Arcadia, Bell, Industry, Inglewood, Pasadena, Pomona, Monica, Temple City. - The City maintains procedure manuals and up(latt!S periodically. 1 cities should review and abuse and "I-I"''''''V I-IVL...vn",.., mechanism, such as a fraud hotline, to permit the anonymous cOIlcelms. The following should such policies and ,",VJlIH',",vlluaCl, DrClce~Jur'es: Alhambra, Inglewood, Monica, Temple City. City maintains a secure anonymous hotline for rpn,Arl',"cr and questionable
R12:
Update and Procedures fraud, questionable practices, including a mechanism for confidential reporting concerns - (1) the City has an Policy in place and individuals ability to concerns confidentially writing.
R13:
should periodically review update internal control DrO,CeclU U'"'-HUIS''''U'-''''' The Following cities should update internal COltltn)l pro(:eaurt~S over financial Industry, Inglewood. City Auditor routinely and reports rpVIP'll<: reports to the deficiencies are "1'"\~... ""r·T",ri to the extent
R14:
have not adopted a policy an unrestricted fund balance than two general fund operating revenues or regular general fund "",,,...,,'1"'," should The following cities should adopt such a policy: Alhambra, comr>toltl. Downey, Glendale, Industry, Pomona, Redondo -'-""'.... v ••, Whittier. Agree - has adopted a general fund reserve resolution requiring a aUnUI'H.U.. fund which is far greater than two months (or 16%) reciommenCle:Cl uu,,'''''',I:'.l....·y r..,."..nfP unassigned and Charter reserves. publish a timely Annual Financial Report (CAFR). Agree - City ... v ••"U'""" a timely CAFR annually.
R15:
Charter cities must develop and publish a timely Comprehensive Annual Financial Report (CAFR). R1 No from Inglewood, per the Final Report.
R16:
Charter cities that not published financial reports on website should do so. Industry should do so. Agree - on the City's website. 1-'",.,-,..., ..,-.,-, controls over sole sourced ""',,,,...,,,,.., preferential nrp''VPlrn contracts. The should develop such Irwindale, Temple "Ar.1"rA Agree-Both Administrative Policy H~"UU"'''U ''IF''''''''''' sole sourced contracting, requiring COUflcil the value ofcontracts reach a threshold.
R17:
Charter should develop controls over sourced contracting to prevent preferential granting of contracts. The following cities should develop controls: Bell, Industry, Irwindale, and Temple City. 1 - Implemented as reflected in City's purchasing ordinance and administrative procedures.
R18:
City with the recommendation. City is considering development of policies and procedures for selecting and negotiating fair prices architectural and engineering consistent with state codes. 19. All charter cities reviewed in report should provide policies and procedures or ensuring prices negotiated for substantial contract change orders are and reasonable, and "establish internalcontrots over substantial contract change orders so that same contractors not repeatedly awarded contracts
R19:
charter reviewed this should provide and ",~.u......'", for substantial contract change over substantial contract so following cities should do so: Alhambra, Torrance, Whittier. Agree - City has an purchasing and procurement policy, which was recently the an internal audit. Further enhancements are being implemented currently.
R20:
City agrees the recommendation. The City adopted a Purchasing System Inglewood Municipal (IMC) 2, Article 5, Section 2-190 Section adopted November 1980 by Ordinance #2387 and amended April ii, 2006 by Ordinance #06-04. This information
R21:
The City agrees with the recorpmendation. City periodically classification and compensation studies evaluating all civilian and sworn position classifications. In the the City has a and compensation study approximately 2-3 in conjunction with collective bargaining the economic downturn has resulted in reductions in City's workforce, work furloughs, pay reductions, and other give-backs, the hasn't been brought up in last two bargaining 22. All charter city councils of the cities reviewed in report should have access to prevailing municipal and/or salary ranges for comparable cities in order to identify any individual city positions(s) whose salaries the normal salary range for those positions. Approval of any exceptional salaries should be based on justifications of exceptional and unique job responsibilities. The City agrees with recommendation. However, in light of the comments in #R21, the City does not have any immediate plans to accomplish a class and comp study, 1) City hiring is minimal sporadic given our budgetary shortfalls, and the and resources necessary to perform such a study would necessitate the use of funds that are currently for higher priority, operational Finally, there is unlikely to be a position where compensation rate is higher than the 'normal salary of jurisdictions. Thank you for providing us an opportunity to comment on report. 5 o CIT Y F BURBANK FFICE OF THE lTV MANAGER February 13, 2013 Judge County Superior Court nnE!lBS Shortridge Foltz Criminal Justice Center 210 West Temple Street, Floor, Room 11-506 Los CA 90012 Cleml=mts._ On behalf of the City of Burbank, enclosed you will find City's response to
R22:
city councils of the report should have access to prevailing municipal wage rates and/or salary for comparable in order to identify individual city position(s) whose salaries the range for those Approval of exceptional salaries ':>H'''''''U be on justifications of exceptional uniqlle responsibilities. department frequently conducts surveys with ten cities ",,""'nt'I'''''' <:'111'""""" lli In T1 to __ \6t~ BTER CITIES - RECOMMENDATIONS RECOMMENDATIONS are required from the following charter cities: Alhambra Arcadia Burbank Compton Culver City Downey Glendale Industry Inglewood Inwindale Palmdale Redondo Beach Signal Hill Vernon
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Findings & Recommendations
9 findings
F1:
The “Carve-Out” program, currently used by the Fire Department, not only reduces the time needed to refer injured workers to medical personnel, but also minimizes the number of disputes regarding LC 4850 eligibility resulting from medical treatment plans and opinions.
F2:
Although California Labor Code §3812 et seq. recognizes the concept of certain “presumptive” injuries associated with safety workers, cities and counties may rebut these presumptions based on available eye witnesses and applicable case infor- mation.
F3:
Conducting analyses of on-the-job injuries incurred by County safety workers should assist County departments to identify the most frequently occurring injuries, and as- sist the departments to develop specific training programs to reduce the occurrence of these injuries.
F4:
Individuals on LC 4850 leave may seek ways to manipulate the program’s rules and regulations to gain more than one year of benefits.
F5:
The American College of Occupational and Environmental Medicine (ACOEM) pub- lishes researched and tested guidelines covering on-the-job injuries and effective quality of care, reduction of unnecessary medical procedures, and full health restora- tion recommendations. These standards are included in the Medical Treatment Utili- zation Schedule (MTUS). The standards are used by several of the counties sur- veyed by the CGJ.
F6:
The Sheriff’s Department often uses sworn officers to transport injured workers to scheduled appointments with physicians.
F7:
The Sheriff’s Department often uses sworn officers to conduct drive-by surveillance of officers assigned to their homes as part of their LC 4850 injury recovery plans.
F8:
Data provided by the County’s Risk Management Branch of the Chief Executive Of- fice suggests that individual safety workers may view the benefits of the LC 4850 LABOR CODE §4850 140 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT program as an entitlement, and make efforts to gain LC 4850 status just prior to their planned retirement dates, thereby increasing their final retirement benefits. 8
F9:
Discussions with the County’s Risk Management Branch suggest that on occasion an injured safety worker remains on LC 4850 status after clear evidence is available to indicate that the worker’s disability will prevent him from ever returning to perfor- mance of his duties.
Additional Recommendations
9
Not linked to specific findings.
R1:
The Los Angeles County Sheriff and Probation Departments should adopt the “carve-out” program, as used by the Fire Department, to expedite the process of re- ferring injured workers to approved physicians and to reduce the frequency of LC 4850 eligibility disputes.
R2:
The Los Angeles County Sheriff, Fire, and Probation Departments should con- tinue to review all cases involving presumptive injuries to assure that each injury in question is job-related.
R3:
The Los Angeles County Sheriff and Probation Departments should adopt the practice of the Fire Department by gathering statistics to determine the most com- mon and prevalent on-the-job injuries, and use these statistics to develop specific in- jury prevention and mitigation programs and training.
R4:
The Los Angeles County Sheriff, Fire, and Probation Departments should scru- tinize requests from injured workers seeking to renew additional years of 4850 status by considering whether changes of medical tests, exams, and treatment plans have occurred.
R5:
The Los Angeles County Sheriff, Fire, and Probation Departments should en- sure that the guidelines and standards established by the Medical Treatment Utiliza- tion Schedule (MTUS), which includes American College of Occupational and Envi- ronmental Medicine (ACOEM) recommendations, are used when setting treatment plans and time off from work in order to reduce excessive absences.
R6:
The Los Angeles County Sheriff’s Department should consider using non-sworn personnel to transport and accompany newly injured workers to the primary treating physicians, allowing sworn officers to continue with mission-specific duties.
R7:
The Los Angeles County Sheriff’s Department should consider the use of non- sworn personnel or sworn personnel on modified duty to monitor the activities of 8 Source: “Report of the Influence of the State of California Labor Code 4850 and the County of Los An- geles Service Connected Disability Retirements on the County of Los Angeles Workers’ Compensation Program”, January 2005; published by the Chief Administrative Office of the County of Los Angeles LABOR CODE §4850 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 141 workers on LC 4850 leave to ensure full compliance with medical plans, allowing sworn officers to continue with mission-specific duties.
R8:
The Los Angeles County Sheriff, Fire, and Probation Departments should re- view and compare the frequency of employees’ LC 4850 initial claim dates that im- mediately precede their retirement dates, to determine if the LC 4850 program is be- ing used in accordance with its intent.
R9:
The Los Angeles County Board of Supervisors should sponsor or support legisla- tion allowing a public jurisdiction to terminate LC 4850 benefits and authorize disabil- ity pension benefits when clear and convincing evidence exists that an employee’s work-related disability will preclude the worker from ever returning to the perfor- mance of his duties.
Findings & Recommendations
5 findings
F1:
Of the 80 adult detention facilities visited, the following 20 (25%) were found to be exceptional, based on combinations of physical facilities, maintenance, inmate treatment, staff knowledge and background, and/or expressed commitment:
• Arcadia Police Department
• Crescenta Valley Station, LASD*
• Downey Police Department
• Glendale Police Department
• Hawthorne Police Department
• Hermosa Beach Police Department
• Huntington Park Police Department
• Lost Hills (Malibu) Station, LASD
• Manhattan Beach Police Department
• Metropolitan Detention Center (MDC)
• Michael D. Antonovich Antelope Valley Courthouse
• Montebello Police Department
• Monterey Park Police Department
• Palmdale Station, LASD*
• Pasadena Police Department
• Pitchess Detention Center, South LASD
• South Los Angeles Station, LASD*
• Topanga Police Department
• West Valley (Reseda), LAPD
• Whittier Police Department * Indicates the three stations that recently received an award from the Altus Global Al- liance, an international organization that promotes public safety and justice.
F2:
The following detention facilities were found to have programs worthy of commenda- tion and comment:
• Glendale Police Department (A39)1 This facility was highlighted in the CGJ 2009-10 Report, titled “Video-Conference Technology”. The video-arraignment procedure provided in The Glendale Police Department Station continues to be exemplary in 2011-2012. This arraignment process could be a model for LA County law enforcement agencies. The staff was willing and able to share information and expertise with other detention facili- ties. See Appendix A for identification codes. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 415
• Hawthorne Police Station (A42) The CGJ found the insight provided by one of the jailers especially valuable. That jailer, with many years of experience, applied his experience and wisdom as a valuable guide in the planning and general design of the configuration of the new Hawthorne Detention Facility.
• Lost Hills Sheriff’s Station (A59) The Lost Hills Sheriff’s Station is located in a high fire risk area. Presently, if there were a large fire and horses needed to be evacuated, they would be trans- ported to an equestrian facility at Pierce College in Woodland Hills for temporary protective housing. To extend the protection of animals, the Lost Hills Sheriff’s Station is currently building a kennel to house canines and felines should evac- uation be necessary for fire protection during future emergencies.
• Metropolitan Detention Center (A68) The Metropolitan Detention Center (MDC) is a new, state-of-the-art facility which opened in February 2011. It has modern equipment including electronic controls, an Automated External Defibrillator (AED) in most areas, and Policies and Pro- cedures online. It also has 24 hour medical services on site. The facility is well run and well maintained.
• Palmdale Station (A81) Palmdale Station is an exceptionally well run and maintained station located in a modern facility built in 2006. The entire operation of the facility and discipline re- flected in its operation reflect the ”Ethics Based” program initiated by the Los An- geles Sheriff’s Department. By all accounts and observable measures the program is excellent. This station is unique in its cooperation and proximity of location to other public service facili- ties. Palmdale General Hospital and Antelope Valley Hospital are both nearby. In addition, a fire station and an armory are closely positioned and would be used in the event of a major emergency. The station has received an international award for its exemplary and efficient “line-of-sight” design. Additionally and of particular note, three Los Angeles County Sheriff’s Department facilities earned international awards for its achievements as a “Citizen-Centric Organization”. To achieve that status, five core aspects of a police station and related services provided were scored. Those areas are community orientation, physical conditions, equal treatment of the public, transparency and accountability, and detention conditions. Palmdale Station was given the top award for its achievements. The award con- ference was hosted by the Altus Global Alliance, a group of six academic centers and non-governmental organizations on five continents which worked in partner- ship with government institutions to strengthen the delivery of public safety and justice. DETENTION COMMITTEE 416 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT The Los Angeles County Sheriff’s Department’s Palmdale Station, its personnel, and the Los Angeles County Sheriff’s Department deserve particular recognition from the CGJ for achieving this highest of honors from a recognized independent international organization.
• Pitchess Detention Center - South (A89) The CGJ found the Pitchess Detention Center continues to be a blueprint for success. The date of the CGJ site inspection coincided with the sixth graduation ceremony at the detention center. The graduation theme, “Best Foot Forward,” centered on an on-going LASD program known as “Maximizing Education Reaching Individual Transformation” (MERIT) program. It was found to be an exceptional program which provides hope, inspiration and guidance to soon-to- be-released inmates. The CGJ interfaced with a number of the inmates participating in the ceremony. Several inmates told the CGJ what the program meant to them. For instance, one inmate said he now has a sense of purpose, a new hope, and a commitment to changing his life. Other inmates expressed similar responses to the CGJ. The CGJ noted the great sense of camaraderie and spirit of the speakers expressed at the graduation. An all-inmate band called “The Contra Band” played inspira- tional songs, and provided “musical bookends” to the graduation ceremony.
• Whittier Police Department (A125) The Whittier Police Department (WPD) is a new, state-of-the-art police headquar- ters which opened October 26, 2010. There are a number of social services supporting agencies housed in the building. A “soft room” provides personal security and comfort for traumatized crime vic- tims. A children’s play room is filled with toys and children’s furniture. A Crime Analysis Unit, Crime Scene Investigation, and a Forensic Bureau are also locat- ed on the site. This collection of agencies provides technical support: evidence collecting, video taping, photography, development and comparison of finger- prints, and crime scene diagram construction. The WPD is one of nine police agencies in Los Angeles County designated as a Latent Input Terminal for the Los Angeles County Region Identification System where fingerprint comparison is done by forensic specialists. Testimony often re- lies upon this level of forensic evidence. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 417
F3:
Of the 16 Juvenile facilities CGJ visited, three (19%) were found to be exceptional based on educational programs, physical facilities, maintenance, inmate treatment, staff knowledge and background, and/or expressed commitment:
• Gonzales Youth Camp (Y18)2
• Scott Girls Camp (Y27)
• Scudder Girls Camp (Y28)
F4:
Several detention facilities were found to have specific areas of concern: Los Angeles Sheriff’s Department:
• Alhambra Courthouse (A2) has an open area where detainees are brought into the court on the 2nd floor. There are no secure holding cells where the detainees wait for court hearings on the 2nd floor, causing a potential risk to sheriffs or civil- ians.
• Avalon Station (A7) is an older station with some open wires hanging down in line of sight. The workstations are outdated. There is no video for surveillance of the station. The sobriety cell does not have a soft floor.
• Central Regional Detention Facility (A20) is a large facility where staff needs to be added as there are no funds for overtime. If someone is ill there are no funds for a replacement deputy for that period of time.
• East Los Angeles Station (A32) is a busy station with a sobering cell that needs a standard non-porous floor. The current flooring causes an unpleasant odor that permeates the area. The deputies in the jail use the same telephone line as the main station. The phone line is frequently busy, so they have difficulty com- municating with officers in cars transporting new detainees to the jail.
• Glendale Courthouse (A38) shares a parking lot for the delivery and return of inmates with a nearby public business facility, creating a potential safety risk to the public. The transportation of inmates typically occurs at the business facility’s most busy time. Furthermore, it can occur at dusk in the winter when visibility is obstructed. The barbed wire sally port is non-standard and contributes to a po- tential risk issue.
• Industry Station (A47) The visitation booth is inoperable and needs repair.
• Men’s Central Jail (A65) needs more safety bars in the shower area. There is a need for increased staffing for additional security.
• Mental Health Courthouse (A66) is located in an old manufacturing building that has been modified for use as a court. Mentally ill patients await court hear- ings in an open patio area adjacent to the general population.
• Metropolitan Traffic Courthouse (A67) lacks cameras and viewing monitors for security. The toilet facilities are porcelain and could be a safety issue.
• Pitchess Detention Center - East Facility (A87) is a jail housing a large num- ber of high-risk detainees. More supervision is necessary for the security of the station. See Appendix B for identification codes. DETENTION COMMITTEE 418 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
• Pitchess Detention Center - South Facility (A89) is a jail housing a large num- ber of high-risk detainees. More supervision is necessary for the security of the station. The facility lacks video monitoring in the barracks and dining room.
• Pitchess North - County Correctional Facility (A90) is a jail housing a large number of high-risk detainees. More supervision is necessary for the security of the station.
• Santa Clarita Valley Station (A 101) handles a large number of inmates and is understaffed with only one jailer. The jailer must take care of booking, and in ad- dition, jail maintenance. The jail was so dirty it had to be closed for a day in or- der to be commercially cleaned. The jail lacked a sally port, video surveillance equipment, and a soft floor in the sobering cell.
• Van Nuys (West) Court (A115) had only a digital copy of Policies and Proce- dures. They had no hard copy for easy reference. Los Angeles Police Department:
• Central Area Police Station (A18) is located in a large facility where arrestees are cuffed to benches while officers write reports prior to booking at MDC. There is only a small monitor for the Watch Commander’s use. In addition, the ar- restees have no designated restroom facilities, therefore public restrooms are used.
• Northeast (LA/Eagle Rock) Station (A76) typically holds arrestees in cells for only a few hours before sending them to MDC. CGJ observed an arrestee re- questing use of a restroom. Because there was no toilet in the jail cells, the of- ficer escorted the inmate to a restroom. As the arresting officer entered the cell, CGJ noticed that his weapon was holstered because there were no gun lockers located outside the jail cell area.
• Van Nuys Division Police Station (A116) had no sally port for transporting de- tainees. This causes a security issue. Alhambra Police Department
• Alhambra Police Station (A3) There is no secure area in the booking area be- tween the staff and detainees. Arcadia Police Department
• Arcadia Police Station (A6) has a sobering cell with a partial wall. Detainees are able to climb on the wall and break the sprinklers causing a slipping or flood- ing hazard. Bell Gardens Police Department
• Bell Gardens Police Station (A10) is located in an older building. The sobering cells have no soft padding, causing a hazard for the detainees. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 419 Los Angeles County Probation Department
• Challenger (Y12-14), Mendenhall (Y21), Munz (Y23), Scott (Y27), and Scud- der (Y28) Camps. These juvenile detention facilities are located in outlying areas and must frequently transport youth great distances for medical services to the Los Angeles County + USC Hospital. This causes a burden on the staffing at the juvenile facilities, and delays the treatment of the youth.
F5:
A large number of detention facilities share areas of concern: 3
• Many detention facilities were built at least 40 years ago. Most are functioning well despite needing major physical updates as some are in seriously compro- mised condition.
• A number of detention facilities have limited video equipment for surveillance of the inmates for supervision.
• Several of the jails need to upgrade or better maintain sobering cells’ soft flooring for the safety and security of inebriated detainees.
• Some of the facilities lack Automated External Defibrillators and the staff is often not trained in the use of the equipment.
• Approximately 16% inmates housed at Los Angeles County detention facilities have mental health issues which require additional services. (See 2011-2012 CGJ Medications for Inmates report.) Specialized and ongoing training is im- portant for the security of the facilities.
• Some safety gear, such as flashlights, hard hats, and other equipment used in earthquake or fire drills, is placed in obscure, unmarked locations in the facilities.
• Some detention facilities are under-staffed, based on CGJ’s observations. Appendix A identifies specific facilities. DETENTION COMMITTEE 420 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
21
Not linked to specific findings.
R1:
Alhambra Courthouse (A2)
• Provide secure holding cell for detainees awaiting court procedures on the 2nd floor.
R2:
Avalon Station (A7)
• Repair electrical wiring in the station.
• Improve ergonomics in workstations.
• Provide video surveillance in station.
• Provide soft floor in sobering cell.
R3:
Central Regional Detention Facility (A20)
• Increase staffing ratios to allow for overtime if necessary.
R4:
East Los Angeles Station (A32)
• Provide standard soft flooring in sobering cell.
• Provide jail with a dedicated telephone line.
R5:
Glendale Courthouse (A38)
• Arrange transportation so public does not share open area with inmates waiting for transportation.
• Address sally port for public and personnel safety.
R6:
Industry Station (A47)
• Repair visitation booth.
R7:
Men’s Central Jail (A65)
• Improve and increase number of grab bars in shower area.
• Increase staffing ratios to allow for overtime if necessary.
R8:
Mental Health Courthouse (A66)
• Remodel the facility as possible.
R9:
Metropolitan Traffic Courthouse (A66)
• Provide video equipment for security.
• Update toilets.
R10:
Pitchess Detention Center – East Facility (A87)
• Increase staffing for security. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 421
R11:
Pitchess Detention Center - South Facilities (A89)
• Increase staffing for security.
• Provide video surveillance in the barracks and dining rooms in the South facil- ity.
R12:
Pitchess Detention North-County Correctional Facility (A90)
• Increase staffing for security.
R13:
Santa Clarita Valley Station (A101)
• Provide soft flooring for sobering cells.
• Provide video equipment to monitor cells.
• Construct a sally port.
• Address staffing issues.
R14:
Van Nuys (West) Court (A115)
• Provide a printed copy of Policies and Procedures for staff use. Los Angeles Police Department
R15:
Central Area Police Station (A18)
• Provide designated toilet facilities for arrestees, or provide and post a protocol for use of the public rest room for arrestees.
• Update video monitor for security.
R16:
Northeast (LA Eagle Rock) Station (A76)
• Provide gun lockers for safety of officers entering detention cells.
• Provide toilet facilities for arrestees, or provide and post a protocol for use of the public restroom for arrestees.
R17:
Van Nuys Division Police Station (A116)
• Provide sally port. Alhambra Police Department
R18:
Alhambra Police Station (A3)
• Provide a secure area for booking process in the station. Arcadia Police Department
R19:
Arcadia Police Station (A6)
• Address the construction of the partial wall in the sobering cell. Bell Gardens Police Department
R20:
Bell Gardens Police Station (A10)
• Provide soft flooring in sobering cells. DETENTION COMMITTEE 422 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Los Angeles County Probation Department
R21:
Juvenile Detention Facilities: Challenger (Y12-14), Mendenhall (Y21), Munz (Y23), Scott (Y27) and Scudder (Y28)
• Negotiate and provide contracts with a local medical hospital or an appropri- ate facility for medical services. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 423
Findings and recommendations not yet extracted.
Findings & Recommendations
6 findings
F1:
DCA does not have a dedicated hotline and webpage to make DCA services more accessible to foster youth. These resources could assist youth in filing a consumer complaint, speaking directly with DCA staff, and scheduling one-on-one consumer counseling. In discussion with high-level staff at the DCA, they agreed that there was a cost-effective solution to this issue that would be targeted specifically to the TAY population, if the Board of Supervisors provided the necessary funding.
F2:
DCA has held pilot consumer education workshops for TAYs at group homes and probation facilities. These presentations were given to TAYs to assist them in transitioning to adulthood outside of the foster care system and be more self- sufficient. Expanded workshops could teach foster youth and their care providers (such as social workers, probation officers, group home staff, and foster parents) how to identify, prevent and resolve top consumer issues such as identity theft, landlord/tenant disputes, car purchasing difficulties, education scams, and credit/finance problems.
F3:
DCA agreed that since their staff had a larger population of volunteers (approximately 75) than actual salaried employees (approximately 50), and that they could solicit additional volunteers, specifically targeting the senior citizen population. This is a population of citizens that has not specifically been targeted in the past. Volunteers not only answer phones and assist individuals with consumer issues, but also accompany individuals when they are pursuing such things as housing and transportation needs. This would be of great service to TAYs who for the most part have no previous experience with renting of housing, purchasing a form of transportation, banking, or applying for a job. AGING-OUT - TAY 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 165
F4:
DCA could provide internships in which TAYs can gain first-hand experience in helping consumers resolve financial scams, and learn about how to protect themselves and their friends from consumer fraud. Unpaid internships could be made immediately available. If additional funding were identified, paid internships could also be developed.
F5:
DCFS Youth Development Services Division, Independent Living Program has developed an "Emancipation Resource Directory" that is given to the TAYs when they leave the foster care system. The directory is in dire need of reorganization. This Directory, although it contains excellent information, is not user-friendly and lacks proper organization of the material. Also, the CGJ felt that the contact information to DCA should be listed as one of the first contacts in the directory. Transportation
F6:
MTA has agreed with the action plan made by the Los Angeles County Board of Supervisors to provide "no-cost EZ Transit Passes" on all municipal and rail systems to DCFS and probation youth transitioning out of the county systems, for youth ages 18-21 for a 12 month period. AGING-OUT - TAY 166 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
7
Not linked to specific findings.
R1:
The Department of Consumer Affairs establish a dedicated hotline and webpage for TAYs.
R2:
The Department of Consumer Affairs continue and expand their consumer education workshops for youth preparing to exit the foster care system (ages 16-18), at group homes, probation facilities, and designated locations per DCFS requirements for TAYs prior to their leaving foster care and probation. These consumer education workshops should address specific consumer issues facing TAYs as they prepare for adulthood to help them identify, prevent and resolve consumer issues, such as landlord/tenant disputes, car purchasing difficulties, education scams, credit/finance problems, and identity theft.
R3:
The Department of Consumer Affairs actively solicit volunteers, including those from the senior citizen population, to assist TAYs with consumer issues during their transition to adulthood, and also have volunteers accompany TAYs when they are seeking things such as transportation needs, renting of housing, banking, and applying for a job.
R4:
The Department of Consumer Affairs provide unpaid internships for TAYs so they could gain first-hand experience in helping consumers resolve financial scams, and learn about how to protect themselves and their friends from consumer fraud. DCA consider establishing paid internships with a stipend.
R5:
The Department of Children and Family Services Youth Development Services Division, Independent Living Program reorganize the Emancipation Resource Directory to a more user-friendly document with the contact information for DCA listed as one of the first contacts in the directory, and that physical copies be bound for easy access and use by TAYs.
R6:
The Metropolitan Transit Authority Board of Directors follow through with their commitment slated to begin 7/1/12, to provide "no-cost EZ Transit Passes" on all municipal and rail systems to DCFS and probation youth transitioning out of the county systems, for youth ages 18-21, for longer than a 12 month period, and on a continuing basis until the youth reaches his or her 22nd birthday. AGING-OUT - TAY 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 167
R18-21:
for a 12 month period.
Findings & Recommendations
6 findings
F1:
DCA does not have a dedicated hotline and webpage to make DCA services more accessible to foster youth. These resources could assist youth in filing a consumer complaint, speaking directly with DCA staff, and scheduling one-on-one consumer counseling. In discussion with high-level staff at the DCA, they agreed that there was a cost-effective solution to this issue that would be targeted specifically to the TAY population, if the Board of Supervisors provided the necessary funding.
F2:
DCA has held pilot consumer education workshops for TAYs at group homes and probation facilities. These presentations were given to TAYs to assist them in transitioning to adulthood outside of the foster care system and be more self- sufficient. Expanded workshops could teach foster youth and their care providers (such as social workers, probation officers, group home staff, and foster parents) how to identify, prevent and resolve top consumer issues such as identity theft, landlord/tenant disputes, car purchasing difficulties, education scams, and credit/finance problems.
F3:
DCA agreed that since their staff had a larger population of volunteers (approximately 75) than actual salaried employees (approximately 50), and that they could solicit additional volunteers, specifically targeting the senior citizen population. This is a population of citizens that has not specifically been targeted in the past. Volunteers not only answer phones and assist individuals with consumer issues, but also accompany individuals when they are pursuing such things as housing and transportation needs. This would be of great service to TAYs who for the most part have no previous experience with renting of housing, purchasing a form of transportation, banking, or applying for a job. AGING-OUT - TAY 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 165
F4:
DCA could provide internships in which TAYs can gain first-hand experience in helping consumers resolve financial scams, and learn about how to protect themselves and their friends from consumer fraud. Unpaid internships could be made immediately available. If additional funding were identified, paid internships could also be developed.
F5:
DCFS Youth Development Services Division, Independent Living Program has developed an "Emancipation Resource Directory" that is given to the TAYs when they leave the foster care system. The directory is in dire need of reorganization. This Directory, although it contains excellent information, is not user-friendly and lacks proper organization of the material. Also, the CGJ felt that the contact information to DCA should be listed as one of the first contacts in the directory. Transportation
F6:
MTA has agreed with the action plan made by the Los Angeles County Board of Supervisors to provide "no-cost EZ Transit Passes" on all municipal and rail systems to DCFS and probation youth transitioning out of the county systems, for youth ages 18-21 for a 12 month period. AGING-OUT - TAY 166 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
7
Not linked to specific findings.
R1:
The Department of Consumer Affairs establish a dedicated hotline and webpage for TAYs.
R2:
The Department of Consumer Affairs continue and expand their consumer education workshops for youth preparing to exit the foster care system (ages 16-18), at group homes, probation facilities, and designated locations per DCFS requirements for TAYs prior to their leaving foster care and probation. These consumer education workshops should address specific consumer issues facing TAYs as they prepare for adulthood to help them identify, prevent and resolve consumer issues, such as landlord/tenant disputes, car purchasing difficulties, education scams, credit/finance problems, and identity theft.
R3:
The Department of Consumer Affairs actively solicit volunteers, including those from the senior citizen population, to assist TAYs with consumer issues during their transition to adulthood, and also have volunteers accompany TAYs when they are seeking things such as transportation needs, renting of housing, banking, and applying for a job.
R4:
The Department of Consumer Affairs provide unpaid internships for TAYs so they could gain first-hand experience in helping consumers resolve financial scams, and learn about how to protect themselves and their friends from consumer fraud. DCA consider establishing paid internships with a stipend.
R5:
The Department of Children and Family Services Youth Development Services Division, Independent Living Program reorganize the Emancipation Resource Directory to a more user-friendly document with the contact information for DCA listed as one of the first contacts in the directory, and that physical copies be bound for easy access and use by TAYs.
R6:
The Metropolitan Transit Authority Board of Directors follow through with their commitment slated to begin 7/1/12, to provide "no-cost EZ Transit Passes" on all municipal and rail systems to DCFS and probation youth transitioning out of the county systems, for youth ages 18-21, for longer than a 12 month period, and on a continuing basis until the youth reaches his or her 22nd birthday. AGING-OUT - TAY 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 167
R18-21:
for a 12 month period.
Findings & Recommendations
2 findings
F1:
CBMWD currently does not have a Chief Financial Officer and uses a consultant for financial advice for investments.
F2:
CBMWD serves a large number of cities with a high density of citizens but is under- represented on the voting Board of the MWD. Votes are determined by the assessed value of the residents’ properties, rather than population and water use.
Additional Recommendations
3
Not linked to specific findings.
R1:
The Central Basin Municipal Water District should hire a Chief Financial Officer or the equivalent to ensure financial stability and a viable investment portfolio.
R2:
The Central Basin Municipal Water District should develop effective accounting policies and procedures, effective internal controls, and separate the authority and the responsibility of handling of assets.
R3:
The Central Basin Municipal Water District should hire a purchasing officer or the equivalent to oversee procurement and contracts CENTRAL BASIN MWD 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 379
Findings & Recommendations
2 findings
F1:
CBMWD currently does not have a Chief Financial Officer and uses a consultant for financial advice for investments.
F2:
CBMWD serves a large number of cities with a high density of citizens but is under- represented on the voting Board of the MWD. Votes are determined by the assessed value of the residents’ properties, rather than population and water use.
Additional Recommendations
3
Not linked to specific findings.
R1:
The Central Basin Municipal Water District should hire a Chief Financial Officer or the equivalent to ensure financial stability and a viable investment portfolio.
R2:
The Central Basin Municipal Water District should develop effective accounting policies and procedures, effective internal controls, and separate the authority and the responsibility of handling of assets.
R3:
The Central Basin Municipal Water District should hire a purchasing officer or the equivalent to oversee procurement and contracts CENTRAL BASIN MWD 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 379
Additional Recommendations
66
Not linked to specific findings.
R1:
All charter cities reviewed in this report should adopt financial planning, revenue and expenditure policies to guide cities’ officials to develop sustainable, balanced budg- ets.
R2:
All charter cities reviewed in this report should develop a balanced budget and commit to operate within budget constraints.
R3:
All charter cities reviewed in this report should commit to not using one-time reve- nues to fund recurring or on-going expenditures.
R4:
All charter cities reviewed in this report should adopt multi-year budgets for better planning to ensure the delivery of basic services before funding projects of lower pri- ority.
R5:
All charter cities reviewed in this report should adopt a method and practice of sav- ing into a reserve or “rainy day” fund to be supplement operating revenue in years of short fall.
R6:
Charter cities should develop and adopt a strategic plan that articulates the mission, vision, core values and priorities (goals and objectives) for the City. The following cities should develop and adopt such a strategic plan: Arcadia, Compton, Industry, Inglewood.
R7:
Charter cities should develop and report on performance measures or indicators to evaluate outcomes or progress on priorities. These performance measures should be quantified, focused on outcomes or results, and information should be provided for several years to allow evaluation of progress over time. The following cities should develop such performance measures for indicators: Arcadia, Bell, Compton, Industry, Inglewood, Lancaster, Temple City.
R8:
Charter city councils should continue to maintain a governance policy that specifical- ly defines the relationship between the council and executive. Charter city councils should continue providing specific annual goals for the city’s executive (City Manag- er or City Administrator) and conduct meaningful evaluations annually. The following cities should do so: Alhambra, Bell, Industry, Inglewood, Lancaster. CHARTER CITIES – RECOMMENDATIONS 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 57
R9:
Charter cities should formally establish an audit committee making it directly respon- sible for the work of the independent auditor. The following cities should formally establish an audit committee: Alhambra, Arcadia, Bell, Cerritos, Compton, Industry, Inglewood, Irwindale, Palmdale, Pomona, Santa Monica, Signal Hill, Temple City, Torrance, Whittier.
R10:
All charter cities reviewed in this report should continue requiring compliance with standards of independence for the external auditor. Cities that do not currently se- lect the auditor through a competitive process should do so. Cities that allow the auditor to provide non-audit services should ensure appropriate review and approval of those services.
R11:
Charter cities should review and update accounting policies and procedures to en- sure they are appropriately detailed and define the specific authority and responsibility of employees. Cities should also establish a policy requiring policies and procedures to be reviewed annually and updated at least once every three years. The following cities should review and update accounting policies and proce- dures at least once every three years: Alhambra, Arcadia, Bell, Burbank, Industry, Inglewood, Lancaster, Pasadena, Pomona, Santa Monica, Temple City.
R12:
Charter cities should review and update policies and procedures for reporting fraud, abuse and questionable practices including a practical mechanism, such as a fraud hotline, to permit the confidential, anonymous reporting of concerns. The following cities should adopt such policies and procedures: Alhambra, Arcadia, Burbank, In- dustry, Inglewood, Irwindale, Santa Monica, Temple City.
R13:
Charter cities should periodically review and update internal control procedures over financial management. The Following cities should review and update internal con- trol procedures over financial matters: Bell, Industry, Inglewood.
R14:
Charter cities that have not adopted a policy requiring an unrestricted fund balance of no less than two months of regular general fund operating revenues or regular general fund operating expenditures should develop such policies. The following cit- ies should adopt such a policy: Alhambra, Arcadia, Bell, Cerritos, Compton, Downey, Glendale, Industry, Lancaster, Pomona, Redondo Beach, Temple City, Torrance, Vernon, Whittier.
R15:
Charter cities must develop and publish a timely Comprehensive Annual Financial Report (CAFR). The city of Bell should do so.
R16:
Charter cities that have not published financial reports on the city’s website should do so. The city of Industry should do so.
R17:
Charter cities should develop controls over sole sourced contracting to prevent pref- erential granting of contracts. The following cities should develop such controls: Bell, Industry, Irwindale, Temple City. CHARTER CITIES – RECOMMENDATIONS 58 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R18:
Charter cities should develop policies and procedures for selecting and negotiating fair prices for architectural and engineering services consistent with state codes. The following cities should develop such policies and procedures: Arcadia, Bell, Cerritos, Industry, Inglewood, Irwindale, Pasadena, Whittier.
R19:
All charter cities reviewed in this report should provide policies and procedures for ensuring prices negotiated for substantial contract change orders are fair and rea- sonable, and establish internal controls over substantial contract change orders so that same contractors not repeatedly awarded contracts. The following cities should do so: Alhambra, Bell, Cerritos, Inglewood, Irwindale, Lancaster, Temple City, Tor- rance, Whittier.
R20:
All charter cities should develop policies and procedures for documenting compli- ance with procurement requirements, and provide contract compliance and oversight and have annual audit oversight with an outside accounting firm. The following cities should do so: Bell, Cerritos, Inglewood, Irwindale, Lancaster, Whittier.
R21:
All charter city councils, and citizens of the cities, reviewed in this report should an- nually review the actual compensation received by employees of their cities.
R22:
All charter city councils of the cities reviewed in this report should have access to prevailing municipal wage rates and/or salary ranges for comparable cities in order to identify any individual city position(s) whose salaries exceed the normal salary range for those positions. Approval of any exceptional salaries should be based on justifications of exceptional and unique job responsibilities. CHARTER CITIES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 59 ACRONYMS AICPA American Institute of Certified Public Accountants CAFR Comprehensive Annual Financial Reports CalPERS California Public Employees Retirement System CFO Chief Financial Officer CGJ Los Angeles County Civil Grand Jury CPCC California Public Contract Code FPPC California Fair Political Practices Commission FY Fiscal Year GAAP Generally Accepted Accounting Principles GAAS Generally Accepted Auditing Standards GAS Government Auditing Standards GASB Governmental Accounting Standards Board GFOA Government Finance Officers Association IIA Institute of Internal Auditors RFP Request for Proposal SWOT Strengths, Weaknesses, Opportunities, and Threats
R23:
Are accounting policies and procedures reviewed annually and updated at least once every three years on a predetermined schedule? o Yes o No
R24:
Do the accounting policies and procedures specifically define the authority and respon- sibility of all employees, including the authority to authorize transactions and the responsibility for safekeeping of assets and records? o Yes o No
R25:
Please provide a copy of the accounting policies and procedures manual.
R26:
Please provide any comments or explanations regarding accounting policies and proce- dures: CHARTER CITIES –
R27:
Does your City have policies and procedures to encourage and facilitate the reporting of fraud or abuse and questionable accounting or auditing practices? o Yes o No
R28:
Does your City have a formally adopted and widely distributed and publicized ethics pol- icy? o Yes o No
R29:
Does your City have a practical mechanism, such as a fraud hotline, to permit the confi- dential, anonymous reporting of concerns about fraud, abuse, or questionable practices? o Yes o No
R30:
Are concerns received regarding fraud, abuse, or questionable practices reviewed by in- ternal auditors, with documentation reviewed by the Audit Committee. o Yes o No
R31:
Please provide a copy of the ethics policy and information on mechanisms for reporting concerns of fraud, abuse, or questionable practices.
R32:
Please provide any comments or explanations regarding reporting of fraud, abuse, and questionable practices:
R33:
Are internal control procedures over financial management formally documented? o Yes o No
R34:
Do internal control procedures include practical means for lower level employees to re- port instances of management override of controls? o Yes o No
R35:
Are internal control procedures evaluated to determine if those controls are adequately designed to achieve their intended purpose, have actually been implemented, and con- tinue to function as designed? o Yes o No
R36:
Are potential internal control weaknesses documented in exception reports? o Yes CHARTER CITIES –
R37:
Is there a process in place to identify changes in what is being controlled or controls themselves, and corrective action plans are developed with an appropriate timeline? o Yes o No
R38:
Please provide a copy of the internal control procedures over financial management.
R39:
Please provide any comments or explanations regarding your responses on internal con- trols:
R40:
Does your City have an internal audit function formally established by charter, enabling resolution, or other legal means? o Yes o No
R41:
Is the work of the internal audit function conducted in accordance with the U.S. General Accounting Office’s Government Auditing Standards? o Yes o No
R42:
Are all reports of the Internal Audit function provided to or available to the Audit Com- mittee? o Yes o No
R43:
Please provide a copy of the formal action establishing the internal audit function.
R44:
Please provide any comments or explanations regarding your responses on internal au- dit: CHARTER CITIES –
R45:
Does your City have a formal policy on the level of unrestricted fund balance to be main- tained in the General Fund? o Yes o No
R46:
Does this policy require an unrestricted fund balance of no less than two months of reg- ular general fund operating revenues or regular general fund operating expenditures? o Yes o No
R47:
Please provide a copy of the formal policy on the level of unrestricted fund balance to be maintained in the General Fund.
R48:
Please provide any comments or explanations regarding your responses on general fund unrestricted fund balance:
R49:
Does your City maintain an accounting system adequate to provide all the data needed for the timely preparation of financial statement for the entire entity in conformity with Generally Accepted Accounting Principles (GAAP)? o Yes o No
R50:
Does your City issue timely financial statements for the entire financial reporting entity in conformity with GAAP as part of a Comprehensive Annual Financial Report (CAFR)? o Yes o No
R51:
Has your City’s financial statements been independently audited in accordance with ei- ther generally accepted auditing standards (GAAP) or Government Auditing Standards (GAS)? o Yes o No
R52:
Are the annual budget documents or CAFR for your City published and readily accessible to the general public on your City’s website? o Yes o No CHARTER CITIES –
R53:
Please provide any comments or explanations regarding your responses on financial and public reporting practices:
R54:
Please provide a list of all employees with total compensation for CY 2011 in excess of $175,000 as reported to the Internal Revenue Service (IRS). Please provide detail about the compensation for each employee (salary, overtime, car allowance, vacation payout, sick leave payout, etc.).
R55:
Please provide any comments or explanations regarding employee compensation:
R56:
Does your City have formally adopted policies and procedures defining competitive bid- ding requirements and practices for the procurement of goods and services? o Yes o No
R57:
Does your City Charter or City ordinance provide exemption from competitive procure- ment requirements of California’s Public Contracting Code? o Yes o No
R58:
Does your City have formally adopted policies and procedures for documenting compli- ance with procurement requirements? o Yes o No
R59:
Does your City have formally adopted policies and procedures for selecting firms that provide architectural and engineering services? o Yes o No
R60:
Does your City have formally adopted policies and procedures for ensuring that prices for negotiated contracts are fair and reasonable? o Yes o No CHARTER CITIES –
R61:
Does your City have formally adopted policies and procedures for ensuring that prices negotiated for contract change orders are fair and reasonable? o Yes o No
R62:
Does your City have formally adopted policies and procedures establishing internal con- trols over sole-source contracting? o Yes o No
R63:
Does your City have formally adopted policies and procedures establishing internal con- trols over contract change orders? o Yes o No
R64:
Does your City have formally adopted policies and procedures for providing contract compliance and oversight? o Yes o No
R65:
Please provide copies of the:
• formal policy defining competitive bidding requirements and practices for the procurement of goods and services,
• City Charter or City ordinance providing exemption from competitive procure- ment requirements of California’s Public Contracting Code,
• formally adopted policies and procedures for documenting compliance with pro- curement requirements,
• formally adopted policies and procedures for selecting firms that provide archi- tectural and engineering services,
• formally adopted policies and procedures for ensuring that prices for negotiated contracts are fair and reasonable,
• formal policy establishing internal controls over sole-source contracting,
• formal policy establishing internal controls over contract change orders,
• formal policy and procedures for providing contract compliance and oversight.
R66:
Please provide any comments or explanations regarding your responses on procure- ment and contracting: CHARTER CITIES –
Additional Recommendations
66
Not linked to specific findings.
R1:
All charter cities reviewed in this report should adopt financial planning, revenue and expenditure policies to guide cities’ officials to develop sustainable, balanced budg- ets.
R2:
All charter cities reviewed in this report should develop a balanced budget and commit to operate within budget constraints.
R3:
All charter cities reviewed in this report should commit to not using one-time reve- nues to fund recurring or on-going expenditures.
R4:
All charter cities reviewed in this report should adopt multi-year budgets for better planning to ensure the delivery of basic services before funding projects of lower pri- ority.
R5:
All charter cities reviewed in this report should adopt a method and practice of sav- ing into a reserve or “rainy day” fund to be supplement operating revenue in years of short fall.
R6:
Charter cities should develop and adopt a strategic plan that articulates the mission, vision, core values and priorities (goals and objectives) for the City. The following cities should develop and adopt such a strategic plan: Arcadia, Compton, Industry, Inglewood.
R7:
Charter cities should develop and report on performance measures or indicators to evaluate outcomes or progress on priorities. These performance measures should be quantified, focused on outcomes or results, and information should be provided for several years to allow evaluation of progress over time. The following cities should develop such performance measures for indicators: Arcadia, Bell, Compton, Industry, Inglewood, Lancaster, Temple City.
R8:
Charter city councils should continue to maintain a governance policy that specifical- ly defines the relationship between the council and executive. Charter city councils should continue providing specific annual goals for the city’s executive (City Manag- er or City Administrator) and conduct meaningful evaluations annually. The following cities should do so: Alhambra, Bell, Industry, Inglewood, Lancaster. CHARTER CITIES – RECOMMENDATIONS 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 57
R9:
Charter cities should formally establish an audit committee making it directly respon- sible for the work of the independent auditor. The following cities should formally establish an audit committee: Alhambra, Arcadia, Bell, Cerritos, Compton, Industry, Inglewood, Irwindale, Palmdale, Pomona, Santa Monica, Signal Hill, Temple City, Torrance, Whittier.
R10:
All charter cities reviewed in this report should continue requiring compliance with standards of independence for the external auditor. Cities that do not currently se- lect the auditor through a competitive process should do so. Cities that allow the auditor to provide non-audit services should ensure appropriate review and approval of those services.
R11:
Charter cities should review and update accounting policies and procedures to en- sure they are appropriately detailed and define the specific authority and responsibility of employees. Cities should also establish a policy requiring policies and procedures to be reviewed annually and updated at least once every three years. The following cities should review and update accounting policies and proce- dures at least once every three years: Alhambra, Arcadia, Bell, Burbank, Industry, Inglewood, Lancaster, Pasadena, Pomona, Santa Monica, Temple City.
R12:
Charter cities should review and update policies and procedures for reporting fraud, abuse and questionable practices including a practical mechanism, such as a fraud hotline, to permit the confidential, anonymous reporting of concerns. The following cities should adopt such policies and procedures: Alhambra, Arcadia, Burbank, In- dustry, Inglewood, Irwindale, Santa Monica, Temple City.
R13:
Charter cities should periodically review and update internal control procedures over financial management. The Following cities should review and update internal con- trol procedures over financial matters: Bell, Industry, Inglewood.
R14:
Charter cities that have not adopted a policy requiring an unrestricted fund balance of no less than two months of regular general fund operating revenues or regular general fund operating expenditures should develop such policies. The following cit- ies should adopt such a policy: Alhambra, Arcadia, Bell, Cerritos, Compton, Downey, Glendale, Industry, Lancaster, Pomona, Redondo Beach, Temple City, Torrance, Vernon, Whittier.
R15:
Charter cities must develop and publish a timely Comprehensive Annual Financial Report (CAFR). The city of Bell should do so.
R16:
Charter cities that have not published financial reports on the city’s website should do so. The city of Industry should do so.
R17:
Charter cities should develop controls over sole sourced contracting to prevent pref- erential granting of contracts. The following cities should develop such controls: Bell, Industry, Irwindale, Temple City. CHARTER CITIES – RECOMMENDATIONS 58 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R18:
Charter cities should develop policies and procedures for selecting and negotiating fair prices for architectural and engineering services consistent with state codes. The following cities should develop such policies and procedures: Arcadia, Bell, Cerritos, Industry, Inglewood, Irwindale, Pasadena, Whittier.
R19:
All charter cities reviewed in this report should provide policies and procedures for ensuring prices negotiated for substantial contract change orders are fair and rea- sonable, and establish internal controls over substantial contract change orders so that same contractors not repeatedly awarded contracts. The following cities should do so: Alhambra, Bell, Cerritos, Inglewood, Irwindale, Lancaster, Temple City, Tor- rance, Whittier.
R20:
All charter cities should develop policies and procedures for documenting compli- ance with procurement requirements, and provide contract compliance and oversight and have annual audit oversight with an outside accounting firm. The following cities should do so: Bell, Cerritos, Inglewood, Irwindale, Lancaster, Whittier.
R21:
All charter city councils, and citizens of the cities, reviewed in this report should an- nually review the actual compensation received by employees of their cities.
R22:
All charter city councils of the cities reviewed in this report should have access to prevailing municipal wage rates and/or salary ranges for comparable cities in order to identify any individual city position(s) whose salaries exceed the normal salary range for those positions. Approval of any exceptional salaries should be based on justifications of exceptional and unique job responsibilities. CHARTER CITIES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 59 ACRONYMS AICPA American Institute of Certified Public Accountants CAFR Comprehensive Annual Financial Reports CalPERS California Public Employees Retirement System CFO Chief Financial Officer CGJ Los Angeles County Civil Grand Jury CPCC California Public Contract Code FPPC California Fair Political Practices Commission FY Fiscal Year GAAP Generally Accepted Accounting Principles GAAS Generally Accepted Auditing Standards GAS Government Auditing Standards GASB Governmental Accounting Standards Board GFOA Government Finance Officers Association IIA Institute of Internal Auditors RFP Request for Proposal SWOT Strengths, Weaknesses, Opportunities, and Threats
R23:
Are accounting policies and procedures reviewed annually and updated at least once every three years on a predetermined schedule? o Yes o No
R24:
Do the accounting policies and procedures specifically define the authority and respon- sibility of all employees, including the authority to authorize transactions and the responsibility for safekeeping of assets and records? o Yes o No
R25:
Please provide a copy of the accounting policies and procedures manual.
R26:
Please provide any comments or explanations regarding accounting policies and proce- dures: CHARTER CITIES –
R27:
Does your City have policies and procedures to encourage and facilitate the reporting of fraud or abuse and questionable accounting or auditing practices? o Yes o No
R28:
Does your City have a formally adopted and widely distributed and publicized ethics pol- icy? o Yes o No
R29:
Does your City have a practical mechanism, such as a fraud hotline, to permit the confi- dential, anonymous reporting of concerns about fraud, abuse, or questionable practices? o Yes o No
R30:
Are concerns received regarding fraud, abuse, or questionable practices reviewed by in- ternal auditors, with documentation reviewed by the Audit Committee. o Yes o No
R31:
Please provide a copy of the ethics policy and information on mechanisms for reporting concerns of fraud, abuse, or questionable practices.
R32:
Please provide any comments or explanations regarding reporting of fraud, abuse, and questionable practices:
R33:
Are internal control procedures over financial management formally documented? o Yes o No
R34:
Do internal control procedures include practical means for lower level employees to re- port instances of management override of controls? o Yes o No
R35:
Are internal control procedures evaluated to determine if those controls are adequately designed to achieve their intended purpose, have actually been implemented, and con- tinue to function as designed? o Yes o No
R36:
Are potential internal control weaknesses documented in exception reports? o Yes CHARTER CITIES –
R37:
Is there a process in place to identify changes in what is being controlled or controls themselves, and corrective action plans are developed with an appropriate timeline? o Yes o No
R38:
Please provide a copy of the internal control procedures over financial management.
R39:
Please provide any comments or explanations regarding your responses on internal con- trols:
R40:
Does your City have an internal audit function formally established by charter, enabling resolution, or other legal means? o Yes o No
R41:
Is the work of the internal audit function conducted in accordance with the U.S. General Accounting Office’s Government Auditing Standards? o Yes o No
R42:
Are all reports of the Internal Audit function provided to or available to the Audit Com- mittee? o Yes o No
R43:
Please provide a copy of the formal action establishing the internal audit function.
R44:
Please provide any comments or explanations regarding your responses on internal au- dit: CHARTER CITIES –
R45:
Does your City have a formal policy on the level of unrestricted fund balance to be main- tained in the General Fund? o Yes o No
R46:
Does this policy require an unrestricted fund balance of no less than two months of reg- ular general fund operating revenues or regular general fund operating expenditures? o Yes o No
R47:
Please provide a copy of the formal policy on the level of unrestricted fund balance to be maintained in the General Fund.
R48:
Please provide any comments or explanations regarding your responses on general fund unrestricted fund balance:
R49:
Does your City maintain an accounting system adequate to provide all the data needed for the timely preparation of financial statement for the entire entity in conformity with Generally Accepted Accounting Principles (GAAP)? o Yes o No
R50:
Does your City issue timely financial statements for the entire financial reporting entity in conformity with GAAP as part of a Comprehensive Annual Financial Report (CAFR)? o Yes o No
R51:
Has your City’s financial statements been independently audited in accordance with ei- ther generally accepted auditing standards (GAAP) or Government Auditing Standards (GAS)? o Yes o No
R52:
Are the annual budget documents or CAFR for your City published and readily accessible to the general public on your City’s website? o Yes o No CHARTER CITIES –
R53:
Please provide any comments or explanations regarding your responses on financial and public reporting practices:
R54:
Please provide a list of all employees with total compensation for CY 2011 in excess of $175,000 as reported to the Internal Revenue Service (IRS). Please provide detail about the compensation for each employee (salary, overtime, car allowance, vacation payout, sick leave payout, etc.).
R55:
Please provide any comments or explanations regarding employee compensation:
R56:
Does your City have formally adopted policies and procedures defining competitive bid- ding requirements and practices for the procurement of goods and services? o Yes o No
R57:
Does your City Charter or City ordinance provide exemption from competitive procure- ment requirements of California’s Public Contracting Code? o Yes o No
R58:
Does your City have formally adopted policies and procedures for documenting compli- ance with procurement requirements? o Yes o No
R59:
Does your City have formally adopted policies and procedures for selecting firms that provide architectural and engineering services? o Yes o No
R60:
Does your City have formally adopted policies and procedures for ensuring that prices for negotiated contracts are fair and reasonable? o Yes o No CHARTER CITIES –
R61:
Does your City have formally adopted policies and procedures for ensuring that prices negotiated for contract change orders are fair and reasonable? o Yes o No
R62:
Does your City have formally adopted policies and procedures establishing internal con- trols over sole-source contracting? o Yes o No
R63:
Does your City have formally adopted policies and procedures establishing internal con- trols over contract change orders? o Yes o No
R64:
Does your City have formally adopted policies and procedures for providing contract compliance and oversight? o Yes o No
R65:
Please provide copies of the:
• formal policy defining competitive bidding requirements and practices for the procurement of goods and services,
• City Charter or City ordinance providing exemption from competitive procure- ment requirements of California’s Public Contracting Code,
• formally adopted policies and procedures for documenting compliance with pro- curement requirements,
• formally adopted policies and procedures for selecting firms that provide archi- tectural and engineering services,
• formally adopted policies and procedures for ensuring that prices for negotiated contracts are fair and reasonable,
• formal policy establishing internal controls over sole-source contracting,
• formal policy establishing internal controls over contract change orders,
• formal policy and procedures for providing contract compliance and oversight.
R66:
Please provide any comments or explanations regarding your responses on procure- ment and contracting: CHARTER CITIES –
Findings & Recommendations
5 findings
F1:
Strategic Directions Too much emphasis on DCFS as the sole solution. The County has not launched a coordinated effort across County departments to mitigate child deaths in a strategic way with system-wide, collaborative solutions. Blaming DCFS for child deaths is, in most cases, inappropriate. The responsibility for the death, particularly in the case of abuse or neglect, belongs to the perpetrator. During this investigation, various participants stated: “DCFS cannot do it alone.” In fact, DCFS is not alone. There are a multitude of agencies, organizations, and individu- als, internal and external to the County, which exist to nurture and protect children in a variety of ways.6 In addition, there are a number of untapped sources of potential sup- port. The missing link is sufficient collaboration among these stakeholders. Lack of a County child death mitigation strategy or agreed-to, coordinated ap- proach across departments. The County lacks a strategy around how to mitigate child deaths across County departments. The emphasis on families in the current plan does not address this issue. Moreover, County departments have not developed an in- tegrated approach for working with at-risk families and children. Senior staff and front- line staff indicated that the tendency is to work in “silos”, both internal to DCFS and across departments, which results in poor communication and collaboration. Antiquated child protection legislation. Some law enforcement officials expressed their concern to the CGJ that the development of child protection legislation is lagging.
• A common comment was that legislation addressing child protection is 20 years behind legislation addressing domestic violence.
• Psychological, emotional, or verbal abuse, neglect, and failure of children to thrive are not sufficiently defined and the question of whether, what, and how to criminalize them is even more unclear. See list provided on of this report. CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 185 Mandated reporting. Various stakeholders – pediatricians and other physicians, sworn officers, therapists, educators, day care operators, clergy, and others who work with children – are mandated to report any signs of child abuse to County authorities. With ICAN’s involvement, the mandated reporting between law enforcement and DCFS is better today, particularly involving domestic violence and emotional abuse, than it has been in the past. Although DCFS provides some training for mandated reporters, senior staff members indicate that mandated reporting is still under-used; for example:
• There are variable rates of reporting by various mandated reporting classes.
• There have been only a few prosecutions for non-reporting.
• There are insufficient standardized mandated reporting definitions and training. Complicating the situation further, various licensing agencies and certification boards are responsible for training their members in the responsibilities of being mandated re- porters. The multiplicity of agencies involved leads to inconsistencies in the monitoring and enforcement of such reporting. Inadequate coverage of family support services in some regions. Already limited funding has been further cut during the economic downturn. Front-line staff members indicate that there are not sufficient support services available in many communities to help stabilize families. The services are deficient in both availability and quality. As a result, children in these under-served areas face increased risk. Impact of Katie A. Settlement Agreement7. In September 2011, the class-action suit, Katie A. v. Bontà (referred to as “Katie A. Settlement”) resulted in an agreement that the system will provide intensive home- and community-based mental health services for California children in foster care or at risk of removal from their families. Under the Set- tlement, California will provide two types of mental health services, “Intensive Home- Based Services” and “Intensive Care Coordination,” available to certain children under Medicaid. The State will also determine what parts of “Therapeutic Foster Care” ser- vices are covered under Medicaid and provide that service to certain class members. Some focus group participants expressed concern about whether the large scale of the Los Angeles County mental health system, which includes over 9,400 individual mental health providers, will allow for the provision of sufficiently flexible and organizationally efficient mechanisms to meet certain of the goals of the Katie A. settlement in all re- gions within the County. County of Los Angeles’ Settlement Agreement for the Katie A., et al., vs. Diana Bontà, et al., (State of California and County of Los Angeles) lawsuit. The five plaintiff foster children requested, in lieu of payment, that “the County and State” improve on their delivery of services to all children and young adults under the custody of DCFS, and/or those at risk of entering the child welfare system. CHILD DEATH MITIGATION 186 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
F2:
Policies and Procedures Improved risk assessment instrument. Senior DCFS staff pointed out that the SDM® instrument needs to be updated. Some of the questions need refinement to assess safety and risk more accurately. Numerous DCFS policies. DCFS estimates that it has 402 policies. Both manage- ment and staff indicated that because of this large number of policies, poor organization of policies, and conflicts among policies, it was impossible to “know”, remember, or find clear answers to policy questions. Policies that are not known, effectively do not exist. Child safety is paramount. There is a growing concern by many, who are internal and external to DCFS, that the pendulum has swung too far in terms of family maintenance and family reunification. Some fear that parents’ rights over-ride child safety in too many cases. A recent State Auditor report on DCFS identified nearly 900 children in homes of relatives that DCFS later determined to be unsafe or inappropriate.8,9 As a result, at the margin, children are not being taken into the system when their safety might be at too high a risk. Mode of death analysis. Determination of the mode of death in a child death case can be problematic; 23% of the child deaths were categorized as Undetermined by the Cor- oner for 2008 through 2011.
• The Coroner has moved more cases into the Undetermined category as a signal to law enforcement and other agencies that additional evidence is needed to take the case out of the Undetermined category.
• The cause of death of an infant or young child is often difficult to determine with- out accurate death scene information and family histories.
• Some death scenes are not being preserved and appropriately addressed by key officials, contributing to the difficulty of determining causes of death: o It is reported that paramedics often intervene and disturb a death scene when it is clear the child is dead. o Some law enforcement personnel may not be appropriately trained to man- age a child death scene. o DCFS CSWs are not trained on how to manage a death scene. Guidelines for open cases. DCFS has received a temporary waiver from the State that allows for 60 days to resolve a case versus the normal State requirement of 30 8 “Oversight of child victims is criticized” by Garrett Therolf, Los Angeles Times, March 30, 2012, page AA6. DCFS had checked the families and homes for criminal and child abuse records and had conducted home visits but did not always complete a detailed home study. It took DCFS an average of 43 days to remove these children from the placements or reassess and approve the homes. CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 187 days. Staff reported many cases are left open and the backlog is continuing to build. The recent State Auditor report indicated that 9,300 child abuse investigations in Los Angeles County were open beyond the State’s 30-day deadline.10 Although improving, more collaboration and cross-reporting among DCFS, DMH, and law enforcement agencies is needed. There are practical differences and a lack of collaboration among DCFS, law enforcement, and Department of Justice (DOJ) that result in difficult-to-manage expectations and undesired outcomes.
• DCFS takes a strength-based approach to risk and family maintenance while law enforcement agencies take an evidence-based approach.
• Cross-reporting between DCFS and law enforcement agencies is inconsistent.
• DCFS CSWs with an open case sometimes fail to cross-report new abuse allega- tions to law enforcement agencies.
• Mental health (including verbal, emotional, or psychological abuse) and domestic violence calls are not commonly reported to DCFS. Such calls, when coupled with the presence of children, are potential high-risk situations for children. (Note: DCFS and DMH have begun work in this area. DCFS and DMH’s Emergency Response Field-based Services (ERP-FRO) are piloting a joint response protocol in which CSWs respond with the PMRT to assess the child’s risk for hospitaliza- tion jointly.) Follow-up of jurisdiction terminated cases. There is little systematic follow up of cases when jurisdiction has been terminated by DCFS to assess effectiveness of the DCFS’s intervention with the family. The CGJ recognizes that DCFS lacks legal authori- ty once jurisdiction is terminated and family participation in any follow-up survey would have to be voluntary. Effective evidence to the courts. Front-line staff members commented that, in a number of cases, the courts were not accepting DCFS’s recommendations. They raised concerns about their ability to provide County Counsel with sufficiently sound ev- idence to support their recommendations.
F3:
Programs and Services Need for better assessments. Los Angeles County has seven Medical Hub Clinics (Hubs) that provide a variety of services to DCFS children: initial medical examinations, mental health screenings, follow-up medical care for some children with identified or complex medical needs, and forensic evaluations. Los Angeles County Department of 10 “Oversight of child victims is criticized” by Garrett Therolf, Los Angeles Times, March 30, 2012, page AA1. CHILD DEATH MITIGATION 188 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Health Services (DHS) operates six of the Hubs11; the seventh Hub is at Children’s Hospital Los Angeles. CSWs collaborate with Public Health Nurses assigned to assist with health care case management of children to determine the need for Hub assessments, but all Hub refer- rals in child abuse and neglect cases go through DCFS. All children newly placed in foster care are referred to Medical Hubs for initial medical examinations. Additional re- ferrals may result when:
• A report to the CPHL initiates an Emergency Response investigation and the in- vestigating CSW refers a child to a Hub for forensic evaluation.
• A health care provider contacts DCFS with new critical information. DCFS contracts with Hubs to assist CSWs to assess children for abuse, but the Hubs do not provide advice on the placement of children. Senior and front-line staff members identified Orangewood Center in Orange County, California, as a good model for inter- agency collaboration and for providing family resources, completing child assessments, and placing children. Need for a more effective reunification process. The reunification process is often a traumatic experience for both the child and family. A high quality transition process can often make the difference between a successful and unsuccessful outcome for the child and the family. Greater attention to high risk neo-natal situations. Many newborn situations, particu- larly those involving teen mothers, drug addiction, or domestic violence, are extremely high risk. Education about effective parenting and critical family support is often lacking. Insufficient focus on child death prevention. DCFS public outreach regarding safe sleeping practices, water safety, pedestrian and motor vehicle safety, and other child safety messages are limited. The County now has a Safe Sleeping Task Force working on educational and awareness programs. Improved suicide prevention services. The Child and Adolescent Suicide Review Team (CASRT) has identified a need for improved transitional care for adolescents and training to address the mental health needs of at-risk children and their families.
• The CASRT has reviewed a number of cases in which adolescents failed to re- ceive sufficient support when they transitioned from in-patient treatment pro- grams back to home and school. The lack of ongoing support during this difficult transition period was seen as a factor that contributed to the eventual suicide of the youth involved. Harbor-UCLA Medical Center, High Desert Multi-Service Ambulatory Care Center (MACC), LAC+USC Medical Center (open 24/7), Martin Luther King, Jr. MACC, Olive View-UCLA Medical Center, and East San Gabriel Valley Satellite to LAC+USC Hub (at former Maclaren Children’s Center in El Monte). CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 189
• Mental Health and medical professionals serving DCFS clients are in need of ad- ditional training to recognize and respond to the suicidal risk of children and ado- lescents in treatment. Poor media image and limited public education. DCFS has a poor media image.
• Media-bashing of DCFS increases the negative perception of DCFS, negatively affecting internal morale and encouraging a risk-averse culture. These impacts affect productivity and indirectly increase the backlog of cases.
• DCFS does not take advantage of the reach of traditional media and new media to provide child safety messages to the public, as already cited.
F4:
Information, Technology, and Processes Insufficient data-sharing and inaccurate information, coupled with inadequate DCFS technology. The County of Los Angeles and DCFS depend on data made available through a variety of information technology (IT) systems that staff members report are inaccurate, inaccessible, incomplete, or out-of-date. All child protective agencies in the State of California are required to use the State’s Child Welfare Services Case Management System (CWS/CMS). DCFS cannot make changes or improvements to the CWS/CMS and, thus, can only urge the State to make any changes. This limitation is also true of other systems which DCFS must rely on but does not control, such as the California Law Enforcement Telecommunications System (CLETS). Specific concerns involved:
• Easy and timely access to performance statistics and management reports that could be generated from CWS/CMS
• The accuracy of CLETS
• Timeliness of the County’s new Family and Children’s Index (FCI), a statutorily defined system that is not within DCFS’s control to a large degree
• Access to data by the lack of tools, particularly in the field
• Lack of a standardized tracking process involving severe injuries or endangered situations
• Lack of DOJ online access to case data, similar to the access granted to SCSWs and CSWs 12 Refers to 70-561.10, Live Scan and California Law Enforcement Telecommunications System (CLETS) Clearances; DCFS has agreed to process Live-Scan fingerprints for relative/non-relative extended family member caregivers of Probation minors. http://www.lacdcfs.org CHILD DEATH MITIGATION 190 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Time-consuming administrative tasks. Senior and front-line staff members indicate that considerable time is spent on addressing DCFS administrative requirements and voluminous policies, rather than working effectively with clients.
• Emergency Response Referrals are only funded up to 30 days. The State has given an extension of 60 days, but it will revert back to 30 days on June 30, 2013.
• Staff members reported they spend an excessive amount of time documenting cases (case narratives). The condensed Investigative Narratives were fully im- plemented in August 2011, but DCFS staff members in the focus groups were not aware of this change.
• CSWs report that they do not have enough time with children and their families. Some reported one visit per month when they feel once per week is a more ap- propriate minimum. Inconsistent management processes. Staff members reported much variation in ad- ministrative, management, and system processes from region to region. They charac- terized the differences as: “each regional administrator does his/her own thing.” Child placement process. The placement process, which can occur any time during a 24-hour cycle, currently requires administrative staff to phone facilities to see if they are willing and able to take a child. This effort is often a time-consuming and frustrating process. There is an allegation that some placement facilities, despite having capacity, refuse to take infants or children with special-needs. Availability and quality of licensed care providers. The licensing and review of care facilities is a State responsibility. Senior and front-line staff members reported that:
• The State cutbacks have reduced the monitoring of these facilities.
• It has become increasingly difficult to place children, particularly young children or children with physical or behavioral problems, even though the care facilities indicate they have openings.
• The placement system needs to be improved, including regular vetting and moni- toring of foster families and group homes.
• There is a lack of capacity or willingness to take babies and or children with spe- cial needs.
• It is reported that SCSWs and CSWs may not always apply the continuum of care model when determining the appropriate placements for children and opt more frequently for Foster Family Agency (FFA) placements – the most costly placements designed for children with more complex diagnoses and needs.
• DCFS is concerned that licensed foster parents are not adequately trained. CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 191
F5:
Organizational Effectiveness County organizational silos. Currently DCFS and many of its internal and external partners essentially operate in silos and interact predominantly in reactive circumstanc- es – intervention and post-mortem reviews. This unsystematic approach is inefficient, wasting resources, compounding work, and limiting positive and holistic outcomes. Lack of continuity in organizational leadership. Senior and front-line staff members indicate that the lack of management continuity at DCFS contributes to uncertainty, negative inertia on strategic priorities, and poor continuity in case management.
• There have been 15 DCFS Directors in 25 years.
• There are high levels of turnover, reassignment, and burnout.
• A strategic planning process has been underway for years, but is still not opera- tional. Work culture. Front-line staff members perceive a disconnect between the DCFS front-line and executive leadership, ARAs, and BOS. Staff reported that a climate of fear and highly bureaucratic processes are affecting productivity and morale and driving staff to be risk averse and defensive. Other comments include:
• DCFS has a risk-averse culture with a lack of urgency, follow-through, accounta- bility, or evidence-based decision-making.
• DCFS administration is more adversarial than supportive.
• Overly bureaucratic requirements seem to cause many supervisors and ARAs to be risk-averse, which ties up sign-off requirements, delays decisions, and reduc- es productivity.
• The DCFS Executive Team and the BOS have unrealistic expectations and a lack of understanding of the uncertainties and difficulties of casework. Caseload, workload, and expectations. Front-line staff members indicate that:
• They are overwhelmed by current caseload levels.
• There is little guidance for referral or caseload management or prioritization.
• The cases are more complicated today with increased drug-related and mental- health issues.
• Families are more aware of their rights and use them to obstruct access and as- sessment.
• They spend up to 75% of their time fulfilling administrative requirements, which severely limit the time available to visit families.
• Some feel overwhelmed by unrealistic, inconsistent, and ever-evolving expecta- tions. CHILD DEATH MITIGATION 192 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
• CSWs disagreed and were confused regarding the merits, need for, and role of specialized programs at DCFS, particularly since CSWs assigned to specialized divisions do not carry caseloads. Some CSWs perceive that this situation exac- erbated their already high caseloads. CPHL referrals and entry. Front-line staff members are concerned about the handling of CPHL referrals.
• The DCFS CPHL generates a high number of referrals that are unmerited.
• Referrals are a reactive process.
• Relatively inexperienced staff members operate the DCFS CPHL and have to make quick determinations on how to rate a call.
• CSWs are sometimes unable to gain entry and undertake the complex assess- ments required by many referrals because: o Contention at entry is increasing because more families are aware of their le- gal rights and options. o Assessments are contentious when drugs, domestic violence, abuse, and particularly sexual abuse is alleged. o Mental instability or behavioral problems require special knowledge, skills, and experience. Support in the event of child fatality cases. Front-line staff members indicate that DCFS does not provide sufficient support to CSWs involved in child fatality cases. They also report that they are not involved in the subsequent reviews of these cases, thus losing valuable learning opportunities. ICAN’s Peer Support Team Program (PST) might be a good model to build on. Internal communications. Front-line staff members indicate inadequate internal communication and training regarding processes and outcomes, which then contribute to a risk-averse and reactive culture.
• There is poor communication within DCFS and with other involved departments.
• Communication skills and tools are deficient at all levels of the organization. Front-line and supervisory skill training. Front-line staff members indicate that skill preparation at DCFS is deficient in terms of quality, quantity, and access. Staff mem- bers at all DCFS levels questioned:
• Whether academic programs adequately prepare social workers for work at DCFS.
• Whether the hiring criteria are sufficiently high for the skills, knowledge, and ex- perience required to accomplish effective social work at DCFS CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 193
• Whether DCFS was ensuring that the Inter-University Consortium is designing programs that meet DCFS’s needs, particularly regarding education and training of first-line supervisors There was a sense that the Training Academy was getting better, but overall there was neither enough training, nor sufficient depth, nor realism regarding the situations front- line staff members face. The experience criterion for supervisors has been lowered from five (5) to three (3) years. Supervisors were described as lacking key communication and mentoring skills and being unable or unwilling to provide the support needed in difficult cases. Staff performance. Front-line staff members are concerned about the lack of well- qualified candidates and under-performing personnel at DCFS.
• Core business performance criteria are not defined and measured.
• Performance seems to be measured by how well forms are filled out and not on real results.
• Onerous Civil Service rules make it almost impossible to terminate underperform- ing or otherwise deficient employees.
• A number of staff members are unqualified or do not carry their full workload.
• Some staff members abuse disability and Worker’s Compensation provisions, two areas requiring effective supervision.
• DCFS staffing levels, personnel distribution, and spans of control are problemat- ic. Lack of consistency. DCFS has a lack of consistency across regions. Line and man- agement staff commented that processes and performance vary from region to region, indicating: “Every regional director does their own thing.” Some local variation is prob- ably a good thing to deal with the unique conditions of the region, but it is inappropriate for service levels and quality to vary dramatically from one part of the County to another.
Additional Recommendations
7
Not linked to specific findings.
R1:
2: Child rights. The BOS, CEO, and the Director of DCFS should take steps for Los Angeles County to become a national leader in the promotion and perpetuation of children’s rights and adopt and maintain a charter for children’s rights. DCFS currently has a children’s rights charter specifically for children in its care in the child welfare system, but the County does not have one for all children. The United States is one of only three countries, including Somalia and South Sudan, which has not joined the international community in supporting the Convention on the Rights of the Child (CRC), an international human rights treaty setting out the civil, polit- ical, economic, social, health, and cultural rights of children. The County of Los Angeles is often known nationwide as a trend-setter and a leader on social issues. Children’s rights should be one of these areas. Although the United States has not adopted the CRC, the County of Los Angeles should reaffirm and pro- mote its own child rights charter as an example for the nation. Children’s rights to a safe and nurturing upbringing should be a societal commitment. 1.2.1. The Director of DCFS should ensure the County’s child rights’ charter for chil- dren in its care is updated and operational within DCFS. The updated charter should also include tighter definitions of what constitutes psychological, emotional, or verbal abuse; neglect; and failure to thrive and are CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 195 consistent with existing penal code definitions. Once tighter definitions and ex- pectations are developed, the BOS will have the ability to lobby for improved leg- islation. This updated charter will help clarify DCFS’s expectations of staff as they carry out their duties. 1.2.2. Although DCFS reports directly to the BOS, the BOS should direct the CEO and involved cluster Deputy CEOs to work with DCFS and the other County depart- ments to develop a children’s rights charter for the BOS to review, refine, and adopt.
R2:
6. A check list for child death investigations. The Coroner, working with law enforcement officials and the Director of DCFS, should develop a check list for law enforcement and DCFS staff of unique factors to look for in child death cases. To address reports that law enforcement officers and DCFS staff members have varying levels of experience and skill in investigating child deaths, a new comprehensive check list could be a first step toward standardization of this important procedure and would provide a valuable training tool that could be improved over time.
R3:
1. A 23-hour assessment center. The Director of DCFS should evaluate the potential for implementing a 23-hour assessment center for children who are at risk, and seek BOS approval based on the results of that evaluation. Such assessment centers, similar to Orangewood in Orange County, California, are staffed with skilled professionals, similar to DCFS CSWs, DMH psychiatric social work- ers, and DPH public health nurses. They can build trust and assess the child in a safe environment, and are more likely to make accurate assessments and appropriate placements if deemed necessary. This recommendation is similar to one made by the CGJ in 1999-2000. (Note: The in- tent of this recommendation is not to replicate the McLaren model of the past.) Given the size of the County, DCFS should pilot one 23-hour assessment center and, once fully operational, evaluate its relative effectiveness and determine if additional centers are warranted.
R4:
1. DCFS technology and information system improvements. The Director of DCFS should work with the State of California to close the gap in the Department’s information needs and propose operational improvements to the systems, particularly interfaces with the State and County systems. This information should then be integrated into DCFS’s own Information Technology (IT) Plan with quick milestones – six months or less – for enhancing access to information critical to effective DCFS operations. A DCFS IT Plan should also outline needed:
• Report writing tools
• Key performance indicators, metrics, and dashboards for monitoring performance and outcomes
• Standard management reports for analyzing data, identifying trends, and making empirically based decisions
• Priorities for approaching the State for system upgrades and refinements, making access to needed data and information easier
R5:
DCFS Focus Groups. To ensure the CGJ had an inclusive top-down/bottom-up perspective on the issues, two focus groups were held with DCFS social workers who have been involved in cases that resulted in children’s deaths. These focus groups provided valuable “front-line” perspectives on current issues and strate- gies for child death mitigation. Among the front-line staff members5 were a total of 47 DCFS CSWs and SCSWs, including union representatives. County Coun- sel also participated in the focus groups.
R6:
Fact and Data Verification. Throughout the investigation, a number of meetings were convened with senior DCFS officials to ensure that data were obtained to support the findings and recommendations and that the recommendations were likely to be effective in the mitigation of child deaths.
R7:
Exit Conference. An Exit Conference was held to discuss the findings and rec- ommendations. The Exit Conference included representatives who attended the Entrance Conference and were joined by Task Force members. Their feedback has been incorporated into the Final Report. The term “front-line” staff member refers to any DCFS employees who interface with the clients or their families, including CSWs, SCSWs, or CPHL staff. CHILD DEATH MITIGATION 184 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Findings & Recommendations
5 findings
F1:
Strategic Directions Too much emphasis on DCFS as the sole solution. The County has not launched a coordinated effort across County departments to mitigate child deaths in a strategic way with system-wide, collaborative solutions. Blaming DCFS for child deaths is, in most cases, inappropriate. The responsibility for the death, particularly in the case of abuse or neglect, belongs to the perpetrator. During this investigation, various participants stated: “DCFS cannot do it alone.” In fact, DCFS is not alone. There are a multitude of agencies, organizations, and individu- als, internal and external to the County, which exist to nurture and protect children in a variety of ways.6 In addition, there are a number of untapped sources of potential sup- port. The missing link is sufficient collaboration among these stakeholders. Lack of a County child death mitigation strategy or agreed-to, coordinated ap- proach across departments. The County lacks a strategy around how to mitigate child deaths across County departments. The emphasis on families in the current plan does not address this issue. Moreover, County departments have not developed an in- tegrated approach for working with at-risk families and children. Senior staff and front- line staff indicated that the tendency is to work in “silos”, both internal to DCFS and across departments, which results in poor communication and collaboration. Antiquated child protection legislation. Some law enforcement officials expressed their concern to the CGJ that the development of child protection legislation is lagging.
• A common comment was that legislation addressing child protection is 20 years behind legislation addressing domestic violence.
• Psychological, emotional, or verbal abuse, neglect, and failure of children to thrive are not sufficiently defined and the question of whether, what, and how to criminalize them is even more unclear. See list provided on of this report. CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 185 Mandated reporting. Various stakeholders – pediatricians and other physicians, sworn officers, therapists, educators, day care operators, clergy, and others who work with children – are mandated to report any signs of child abuse to County authorities. With ICAN’s involvement, the mandated reporting between law enforcement and DCFS is better today, particularly involving domestic violence and emotional abuse, than it has been in the past. Although DCFS provides some training for mandated reporters, senior staff members indicate that mandated reporting is still under-used; for example:
• There are variable rates of reporting by various mandated reporting classes.
• There have been only a few prosecutions for non-reporting.
• There are insufficient standardized mandated reporting definitions and training. Complicating the situation further, various licensing agencies and certification boards are responsible for training their members in the responsibilities of being mandated re- porters. The multiplicity of agencies involved leads to inconsistencies in the monitoring and enforcement of such reporting. Inadequate coverage of family support services in some regions. Already limited funding has been further cut during the economic downturn. Front-line staff members indicate that there are not sufficient support services available in many communities to help stabilize families. The services are deficient in both availability and quality. As a result, children in these under-served areas face increased risk. Impact of Katie A. Settlement Agreement7. In September 2011, the class-action suit, Katie A. v. Bontà (referred to as “Katie A. Settlement”) resulted in an agreement that the system will provide intensive home- and community-based mental health services for California children in foster care or at risk of removal from their families. Under the Set- tlement, California will provide two types of mental health services, “Intensive Home- Based Services” and “Intensive Care Coordination,” available to certain children under Medicaid. The State will also determine what parts of “Therapeutic Foster Care” ser- vices are covered under Medicaid and provide that service to certain class members. Some focus group participants expressed concern about whether the large scale of the Los Angeles County mental health system, which includes over 9,400 individual mental health providers, will allow for the provision of sufficiently flexible and organizationally efficient mechanisms to meet certain of the goals of the Katie A. settlement in all re- gions within the County. County of Los Angeles’ Settlement Agreement for the Katie A., et al., vs. Diana Bontà, et al., (State of California and County of Los Angeles) lawsuit. The five plaintiff foster children requested, in lieu of payment, that “the County and State” improve on their delivery of services to all children and young adults under the custody of DCFS, and/or those at risk of entering the child welfare system. CHILD DEATH MITIGATION 186 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
F2:
Policies and Procedures Improved risk assessment instrument. Senior DCFS staff pointed out that the SDM® instrument needs to be updated. Some of the questions need refinement to assess safety and risk more accurately. Numerous DCFS policies. DCFS estimates that it has 402 policies. Both manage- ment and staff indicated that because of this large number of policies, poor organization of policies, and conflicts among policies, it was impossible to “know”, remember, or find clear answers to policy questions. Policies that are not known, effectively do not exist. Child safety is paramount. There is a growing concern by many, who are internal and external to DCFS, that the pendulum has swung too far in terms of family maintenance and family reunification. Some fear that parents’ rights over-ride child safety in too many cases. A recent State Auditor report on DCFS identified nearly 900 children in homes of relatives that DCFS later determined to be unsafe or inappropriate.8,9 As a result, at the margin, children are not being taken into the system when their safety might be at too high a risk. Mode of death analysis. Determination of the mode of death in a child death case can be problematic; 23% of the child deaths were categorized as Undetermined by the Cor- oner for 2008 through 2011.
• The Coroner has moved more cases into the Undetermined category as a signal to law enforcement and other agencies that additional evidence is needed to take the case out of the Undetermined category.
• The cause of death of an infant or young child is often difficult to determine with- out accurate death scene information and family histories.
• Some death scenes are not being preserved and appropriately addressed by key officials, contributing to the difficulty of determining causes of death: o It is reported that paramedics often intervene and disturb a death scene when it is clear the child is dead. o Some law enforcement personnel may not be appropriately trained to man- age a child death scene. o DCFS CSWs are not trained on how to manage a death scene. Guidelines for open cases. DCFS has received a temporary waiver from the State that allows for 60 days to resolve a case versus the normal State requirement of 30 8 “Oversight of child victims is criticized” by Garrett Therolf, Los Angeles Times, March 30, 2012, page AA6. DCFS had checked the families and homes for criminal and child abuse records and had conducted home visits but did not always complete a detailed home study. It took DCFS an average of 43 days to remove these children from the placements or reassess and approve the homes. CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 187 days. Staff reported many cases are left open and the backlog is continuing to build. The recent State Auditor report indicated that 9,300 child abuse investigations in Los Angeles County were open beyond the State’s 30-day deadline.10 Although improving, more collaboration and cross-reporting among DCFS, DMH, and law enforcement agencies is needed. There are practical differences and a lack of collaboration among DCFS, law enforcement, and Department of Justice (DOJ) that result in difficult-to-manage expectations and undesired outcomes.
• DCFS takes a strength-based approach to risk and family maintenance while law enforcement agencies take an evidence-based approach.
• Cross-reporting between DCFS and law enforcement agencies is inconsistent.
• DCFS CSWs with an open case sometimes fail to cross-report new abuse allega- tions to law enforcement agencies.
• Mental health (including verbal, emotional, or psychological abuse) and domestic violence calls are not commonly reported to DCFS. Such calls, when coupled with the presence of children, are potential high-risk situations for children. (Note: DCFS and DMH have begun work in this area. DCFS and DMH’s Emergency Response Field-based Services (ERP-FRO) are piloting a joint response protocol in which CSWs respond with the PMRT to assess the child’s risk for hospitaliza- tion jointly.) Follow-up of jurisdiction terminated cases. There is little systematic follow up of cases when jurisdiction has been terminated by DCFS to assess effectiveness of the DCFS’s intervention with the family. The CGJ recognizes that DCFS lacks legal authori- ty once jurisdiction is terminated and family participation in any follow-up survey would have to be voluntary. Effective evidence to the courts. Front-line staff members commented that, in a number of cases, the courts were not accepting DCFS’s recommendations. They raised concerns about their ability to provide County Counsel with sufficiently sound ev- idence to support their recommendations.
F3:
Programs and Services Need for better assessments. Los Angeles County has seven Medical Hub Clinics (Hubs) that provide a variety of services to DCFS children: initial medical examinations, mental health screenings, follow-up medical care for some children with identified or complex medical needs, and forensic evaluations. Los Angeles County Department of 10 “Oversight of child victims is criticized” by Garrett Therolf, Los Angeles Times, March 30, 2012, page AA1. CHILD DEATH MITIGATION 188 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Health Services (DHS) operates six of the Hubs11; the seventh Hub is at Children’s Hospital Los Angeles. CSWs collaborate with Public Health Nurses assigned to assist with health care case management of children to determine the need for Hub assessments, but all Hub refer- rals in child abuse and neglect cases go through DCFS. All children newly placed in foster care are referred to Medical Hubs for initial medical examinations. Additional re- ferrals may result when:
• A report to the CPHL initiates an Emergency Response investigation and the in- vestigating CSW refers a child to a Hub for forensic evaluation.
• A health care provider contacts DCFS with new critical information. DCFS contracts with Hubs to assist CSWs to assess children for abuse, but the Hubs do not provide advice on the placement of children. Senior and front-line staff members identified Orangewood Center in Orange County, California, as a good model for inter- agency collaboration and for providing family resources, completing child assessments, and placing children. Need for a more effective reunification process. The reunification process is often a traumatic experience for both the child and family. A high quality transition process can often make the difference between a successful and unsuccessful outcome for the child and the family. Greater attention to high risk neo-natal situations. Many newborn situations, particu- larly those involving teen mothers, drug addiction, or domestic violence, are extremely high risk. Education about effective parenting and critical family support is often lacking. Insufficient focus on child death prevention. DCFS public outreach regarding safe sleeping practices, water safety, pedestrian and motor vehicle safety, and other child safety messages are limited. The County now has a Safe Sleeping Task Force working on educational and awareness programs. Improved suicide prevention services. The Child and Adolescent Suicide Review Team (CASRT) has identified a need for improved transitional care for adolescents and training to address the mental health needs of at-risk children and their families.
• The CASRT has reviewed a number of cases in which adolescents failed to re- ceive sufficient support when they transitioned from in-patient treatment pro- grams back to home and school. The lack of ongoing support during this difficult transition period was seen as a factor that contributed to the eventual suicide of the youth involved. Harbor-UCLA Medical Center, High Desert Multi-Service Ambulatory Care Center (MACC), LAC+USC Medical Center (open 24/7), Martin Luther King, Jr. MACC, Olive View-UCLA Medical Center, and East San Gabriel Valley Satellite to LAC+USC Hub (at former Maclaren Children’s Center in El Monte). CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 189
• Mental Health and medical professionals serving DCFS clients are in need of ad- ditional training to recognize and respond to the suicidal risk of children and ado- lescents in treatment. Poor media image and limited public education. DCFS has a poor media image.
• Media-bashing of DCFS increases the negative perception of DCFS, negatively affecting internal morale and encouraging a risk-averse culture. These impacts affect productivity and indirectly increase the backlog of cases.
• DCFS does not take advantage of the reach of traditional media and new media to provide child safety messages to the public, as already cited.
F4:
Information, Technology, and Processes Insufficient data-sharing and inaccurate information, coupled with inadequate DCFS technology. The County of Los Angeles and DCFS depend on data made available through a variety of information technology (IT) systems that staff members report are inaccurate, inaccessible, incomplete, or out-of-date. All child protective agencies in the State of California are required to use the State’s Child Welfare Services Case Management System (CWS/CMS). DCFS cannot make changes or improvements to the CWS/CMS and, thus, can only urge the State to make any changes. This limitation is also true of other systems which DCFS must rely on but does not control, such as the California Law Enforcement Telecommunications System (CLETS). Specific concerns involved:
• Easy and timely access to performance statistics and management reports that could be generated from CWS/CMS
• The accuracy of CLETS
• Timeliness of the County’s new Family and Children’s Index (FCI), a statutorily defined system that is not within DCFS’s control to a large degree
• Access to data by the lack of tools, particularly in the field
• Lack of a standardized tracking process involving severe injuries or endangered situations
• Lack of DOJ online access to case data, similar to the access granted to SCSWs and CSWs 12 Refers to 70-561.10, Live Scan and California Law Enforcement Telecommunications System (CLETS) Clearances; DCFS has agreed to process Live-Scan fingerprints for relative/non-relative extended family member caregivers of Probation minors. http://www.lacdcfs.org CHILD DEATH MITIGATION 190 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Time-consuming administrative tasks. Senior and front-line staff members indicate that considerable time is spent on addressing DCFS administrative requirements and voluminous policies, rather than working effectively with clients.
• Emergency Response Referrals are only funded up to 30 days. The State has given an extension of 60 days, but it will revert back to 30 days on June 30, 2013.
• Staff members reported they spend an excessive amount of time documenting cases (case narratives). The condensed Investigative Narratives were fully im- plemented in August 2011, but DCFS staff members in the focus groups were not aware of this change.
• CSWs report that they do not have enough time with children and their families. Some reported one visit per month when they feel once per week is a more ap- propriate minimum. Inconsistent management processes. Staff members reported much variation in ad- ministrative, management, and system processes from region to region. They charac- terized the differences as: “each regional administrator does his/her own thing.” Child placement process. The placement process, which can occur any time during a 24-hour cycle, currently requires administrative staff to phone facilities to see if they are willing and able to take a child. This effort is often a time-consuming and frustrating process. There is an allegation that some placement facilities, despite having capacity, refuse to take infants or children with special-needs. Availability and quality of licensed care providers. The licensing and review of care facilities is a State responsibility. Senior and front-line staff members reported that:
• The State cutbacks have reduced the monitoring of these facilities.
• It has become increasingly difficult to place children, particularly young children or children with physical or behavioral problems, even though the care facilities indicate they have openings.
• The placement system needs to be improved, including regular vetting and moni- toring of foster families and group homes.
• There is a lack of capacity or willingness to take babies and or children with spe- cial needs.
• It is reported that SCSWs and CSWs may not always apply the continuum of care model when determining the appropriate placements for children and opt more frequently for Foster Family Agency (FFA) placements – the most costly placements designed for children with more complex diagnoses and needs.
• DCFS is concerned that licensed foster parents are not adequately trained. CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 191
F5:
Organizational Effectiveness County organizational silos. Currently DCFS and many of its internal and external partners essentially operate in silos and interact predominantly in reactive circumstanc- es – intervention and post-mortem reviews. This unsystematic approach is inefficient, wasting resources, compounding work, and limiting positive and holistic outcomes. Lack of continuity in organizational leadership. Senior and front-line staff members indicate that the lack of management continuity at DCFS contributes to uncertainty, negative inertia on strategic priorities, and poor continuity in case management.
• There have been 15 DCFS Directors in 25 years.
• There are high levels of turnover, reassignment, and burnout.
• A strategic planning process has been underway for years, but is still not opera- tional. Work culture. Front-line staff members perceive a disconnect between the DCFS front-line and executive leadership, ARAs, and BOS. Staff reported that a climate of fear and highly bureaucratic processes are affecting productivity and morale and driving staff to be risk averse and defensive. Other comments include:
• DCFS has a risk-averse culture with a lack of urgency, follow-through, accounta- bility, or evidence-based decision-making.
• DCFS administration is more adversarial than supportive.
• Overly bureaucratic requirements seem to cause many supervisors and ARAs to be risk-averse, which ties up sign-off requirements, delays decisions, and reduc- es productivity.
• The DCFS Executive Team and the BOS have unrealistic expectations and a lack of understanding of the uncertainties and difficulties of casework. Caseload, workload, and expectations. Front-line staff members indicate that:
• They are overwhelmed by current caseload levels.
• There is little guidance for referral or caseload management or prioritization.
• The cases are more complicated today with increased drug-related and mental- health issues.
• Families are more aware of their rights and use them to obstruct access and as- sessment.
• They spend up to 75% of their time fulfilling administrative requirements, which severely limit the time available to visit families.
• Some feel overwhelmed by unrealistic, inconsistent, and ever-evolving expecta- tions. CHILD DEATH MITIGATION 192 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
• CSWs disagreed and were confused regarding the merits, need for, and role of specialized programs at DCFS, particularly since CSWs assigned to specialized divisions do not carry caseloads. Some CSWs perceive that this situation exac- erbated their already high caseloads. CPHL referrals and entry. Front-line staff members are concerned about the handling of CPHL referrals.
• The DCFS CPHL generates a high number of referrals that are unmerited.
• Referrals are a reactive process.
• Relatively inexperienced staff members operate the DCFS CPHL and have to make quick determinations on how to rate a call.
• CSWs are sometimes unable to gain entry and undertake the complex assess- ments required by many referrals because: o Contention at entry is increasing because more families are aware of their le- gal rights and options. o Assessments are contentious when drugs, domestic violence, abuse, and particularly sexual abuse is alleged. o Mental instability or behavioral problems require special knowledge, skills, and experience. Support in the event of child fatality cases. Front-line staff members indicate that DCFS does not provide sufficient support to CSWs involved in child fatality cases. They also report that they are not involved in the subsequent reviews of these cases, thus losing valuable learning opportunities. ICAN’s Peer Support Team Program (PST) might be a good model to build on. Internal communications. Front-line staff members indicate inadequate internal communication and training regarding processes and outcomes, which then contribute to a risk-averse and reactive culture.
• There is poor communication within DCFS and with other involved departments.
• Communication skills and tools are deficient at all levels of the organization. Front-line and supervisory skill training. Front-line staff members indicate that skill preparation at DCFS is deficient in terms of quality, quantity, and access. Staff mem- bers at all DCFS levels questioned:
• Whether academic programs adequately prepare social workers for work at DCFS.
• Whether the hiring criteria are sufficiently high for the skills, knowledge, and ex- perience required to accomplish effective social work at DCFS CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 193
• Whether DCFS was ensuring that the Inter-University Consortium is designing programs that meet DCFS’s needs, particularly regarding education and training of first-line supervisors There was a sense that the Training Academy was getting better, but overall there was neither enough training, nor sufficient depth, nor realism regarding the situations front- line staff members face. The experience criterion for supervisors has been lowered from five (5) to three (3) years. Supervisors were described as lacking key communication and mentoring skills and being unable or unwilling to provide the support needed in difficult cases. Staff performance. Front-line staff members are concerned about the lack of well- qualified candidates and under-performing personnel at DCFS.
• Core business performance criteria are not defined and measured.
• Performance seems to be measured by how well forms are filled out and not on real results.
• Onerous Civil Service rules make it almost impossible to terminate underperform- ing or otherwise deficient employees.
• A number of staff members are unqualified or do not carry their full workload.
• Some staff members abuse disability and Worker’s Compensation provisions, two areas requiring effective supervision.
• DCFS staffing levels, personnel distribution, and spans of control are problemat- ic. Lack of consistency. DCFS has a lack of consistency across regions. Line and man- agement staff commented that processes and performance vary from region to region, indicating: “Every regional director does their own thing.” Some local variation is prob- ably a good thing to deal with the unique conditions of the region, but it is inappropriate for service levels and quality to vary dramatically from one part of the County to another.
Additional Recommendations
7
Not linked to specific findings.
R1:
2: Child rights. The BOS, CEO, and the Director of DCFS should take steps for Los Angeles County to become a national leader in the promotion and perpetuation of children’s rights and adopt and maintain a charter for children’s rights. DCFS currently has a children’s rights charter specifically for children in its care in the child welfare system, but the County does not have one for all children. The United States is one of only three countries, including Somalia and South Sudan, which has not joined the international community in supporting the Convention on the Rights of the Child (CRC), an international human rights treaty setting out the civil, polit- ical, economic, social, health, and cultural rights of children. The County of Los Angeles is often known nationwide as a trend-setter and a leader on social issues. Children’s rights should be one of these areas. Although the United States has not adopted the CRC, the County of Los Angeles should reaffirm and pro- mote its own child rights charter as an example for the nation. Children’s rights to a safe and nurturing upbringing should be a societal commitment. 1.2.1. The Director of DCFS should ensure the County’s child rights’ charter for chil- dren in its care is updated and operational within DCFS. The updated charter should also include tighter definitions of what constitutes psychological, emotional, or verbal abuse; neglect; and failure to thrive and are CHILD DEATH MITIGATION 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 195 consistent with existing penal code definitions. Once tighter definitions and ex- pectations are developed, the BOS will have the ability to lobby for improved leg- islation. This updated charter will help clarify DCFS’s expectations of staff as they carry out their duties. 1.2.2. Although DCFS reports directly to the BOS, the BOS should direct the CEO and involved cluster Deputy CEOs to work with DCFS and the other County depart- ments to develop a children’s rights charter for the BOS to review, refine, and adopt.
R2:
6. A check list for child death investigations. The Coroner, working with law enforcement officials and the Director of DCFS, should develop a check list for law enforcement and DCFS staff of unique factors to look for in child death cases. To address reports that law enforcement officers and DCFS staff members have varying levels of experience and skill in investigating child deaths, a new comprehensive check list could be a first step toward standardization of this important procedure and would provide a valuable training tool that could be improved over time.
R3:
1. A 23-hour assessment center. The Director of DCFS should evaluate the potential for implementing a 23-hour assessment center for children who are at risk, and seek BOS approval based on the results of that evaluation. Such assessment centers, similar to Orangewood in Orange County, California, are staffed with skilled professionals, similar to DCFS CSWs, DMH psychiatric social work- ers, and DPH public health nurses. They can build trust and assess the child in a safe environment, and are more likely to make accurate assessments and appropriate placements if deemed necessary. This recommendation is similar to one made by the CGJ in 1999-2000. (Note: The in- tent of this recommendation is not to replicate the McLaren model of the past.) Given the size of the County, DCFS should pilot one 23-hour assessment center and, once fully operational, evaluate its relative effectiveness and determine if additional centers are warranted.
R4:
1. DCFS technology and information system improvements. The Director of DCFS should work with the State of California to close the gap in the Department’s information needs and propose operational improvements to the systems, particularly interfaces with the State and County systems. This information should then be integrated into DCFS’s own Information Technology (IT) Plan with quick milestones – six months or less – for enhancing access to information critical to effective DCFS operations. A DCFS IT Plan should also outline needed:
• Report writing tools
• Key performance indicators, metrics, and dashboards for monitoring performance and outcomes
• Standard management reports for analyzing data, identifying trends, and making empirically based decisions
• Priorities for approaching the State for system upgrades and refinements, making access to needed data and information easier
R5:
DCFS Focus Groups. To ensure the CGJ had an inclusive top-down/bottom-up perspective on the issues, two focus groups were held with DCFS social workers who have been involved in cases that resulted in children’s deaths. These focus groups provided valuable “front-line” perspectives on current issues and strate- gies for child death mitigation. Among the front-line staff members5 were a total of 47 DCFS CSWs and SCSWs, including union representatives. County Coun- sel also participated in the focus groups.
R6:
Fact and Data Verification. Throughout the investigation, a number of meetings were convened with senior DCFS officials to ensure that data were obtained to support the findings and recommendations and that the recommendations were likely to be effective in the mitigation of child deaths.
R7:
Exit Conference. An Exit Conference was held to discuss the findings and rec- ommendations. The Exit Conference included representatives who attended the Entrance Conference and were joined by Task Force members. Their feedback has been incorporated into the Final Report. The term “front-line” staff member refers to any DCFS employees who interface with the clients or their families, including CSWs, SCSWs, or CPHL staff. CHILD DEATH MITIGATION 184 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Findings & Recommendations
8 findings
F1:
CLWA continues to expand its recycled water distribution system under state man- date and duly adopted integrated regional water management plans.
F2:
Recycled water plants are built and operated by the LACSD. CLWA purchases recy- cled water from LACSD and sells to its current single retail recycled water customer, VWA. A significant portion of the funding for CLWA’s current recycled water delivery sys- tem is from State Water Resource Department grants. The awarding of such grants is predicated on the CLWA agreeing to the terms of the Department of Water Re- sources Grant Agreement which includes the mandated reduction of dependency on the Sacramento-San Joaquin Delta water supply. The ad valorem property tax rate on the real property tax bill is calculated by CLWA, and the tax is used to pay for the anticipated cost of delivering potable water to the district via State Water Project as well as for the repayment of the bond issue for the State Water Project construction. Part of the 1% real property tax on all the properties of CLWA’s service area is allo- cated to CLWA to pay for the CLWA’s capital improvements program, including both potable and recycled water systems. Currently, the Tournament Player’s Club golf course is the only recycled water cus- tomer. It pays a monthly facility connection fee to VWA for recycled water access in addition to the cost of actual recycled water used.
F3:
Recycled water is delivered only in dedicated recycled water lines. CLWA has continued to work with retail water purveyors, the LACSD, and other agencies to comply with mandated conservation plan and recycled water use plan to meet the requirements of bills such as Senate Bill 7 (SBX7-7), which mandates that urban water suppliers reduce per capita water use by 20% by 2020 or lose their eli- gibility to State grant funding. There will be new recycled water users when appropriate infrastructure is in place and economic conditions are favorable.
F4:
Under the authority of the Castaic Lake Water Agency Act and duly adopted Resolu- tion No. 2180 in 2002, CLWA is to establish: …its water rate for recycled water, on a volume basis as 80% of normal retail water distributor rate to an end user of the distributor as that rate may change from time to time and authorized the Agency’s General Man- ager to promulgate management procedure orders in furtherance of the Agency recycled water rate; … CASTAIC LAKE WATER AGENCY 384 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Review of a recent recycled water bill to the sole recycled water user showed that the recycled water was billed at more than 93% of the user’s corresponding potable water rate. CONCLUSION CLWA is mandated to provide recycled water in its total service area. See Exhibit A for water recycling requirements imposed on CLWA. The CLWA have operated appropriately within local and state mandates. The CGJ rec- ommends no further action. EXHIBIT A – Water Recycling Requirements ACRONYMS CGJ Los Angeles County Civil Grand Jury CLWA Castaic Lake Water Agency IRWM Integrated Regional Water Management Act LACSD Los Angeles County Sanitation District VWA Valencia Water Agency CASTAIC LAKE WATER AGENCY – EXHIBIT A 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 385 EXHIBIT A Water Recycling Requirements (From an official of the Castaic Lake Water Agency) CLWA has numerous requirements to use recycled water beyond the general benefits that such use generates for our customers. A short list is below:
F5:
State Water Resources Control Board also requires recycled water use as a part of their waste discharge requirements. In 1984, the State Water Board issued Water Quality Or- der No. 84-7 expressing the intent that, pursuant to California Water Code, Section 13142.5(e), in cases where discharges of wastewater to the ocean are proposed in “wa- ter-short” areas, the report of waste discharge should include an explanation as to why the effluent is not being recycled for further beneficial use (SWQCB, 1984).
F6:
SBx7-7 mandates that urban water suppliers reduce statewide water use (in gallons per capita per day) of 10 percent by 2015 and 20 percent by 2020 (20x2020). Methods of complying with SBx7-7 include enhanced water conservation, water use efficiency, and recycled water use.
F7:
Grant eligibility, the Department of Water Resources conditions any grant application on a demonstration, through the documentation in an approved Urban Water Management Plan, that the water provider is on target to meet its 20x2020 goals including the use of recycled water.
F8:
Integrated Regional Water Management Planning, the awarding of grants is predicated on the grantee agreeing to the follow term in the Department of Water Resources Grant Agreement: Since the Grantee’s IRWM region (region) receives water supplied from the Sacramento-San Joaquin Delta (Delta), then the region’s IRWM Plan (existing or any fu- ture update) must help reduce dependence on the Delta for water supply. Other than conservation, the primary way to reduce this dependence is through the substitution of recycled water for potable supplies. 386 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT &,7,=(1 &203/$,17 &,7< 2) /21* %($&+ 8QIXQGHG 3HQVLRQ 5HWLUHPHQW $JH 3LFNXS 3HQVLRQ &200,77(( 0(0%(56 %REEL 0LOOHU ¤ &KDLU /HDK 9 *UDQRI 0DJGDOHQH < +R $QLWD / :RQJ
Findings & Recommendations
1 findings
F2:
/26 $1*(/(6 &2817< Bureau &200,77(( 0(0%(56 'HORUD %URZQ ¤ &KDLU :LOOLDP ) *X]PDQ $QLWD / :RQJ
Findings & Recommendations
1 findings
F2:
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Findings & Recommendations
5 findings
F1:
Of the 80 adult detention facilities visited, the following 20 (25%) were found to be exceptional, based on combinations of physical facilities, maintenance, inmate treatment, staff knowledge and background, and/or expressed commitment:
• Arcadia Police Department
• Crescenta Valley Station, LASD*
• Downey Police Department
• Glendale Police Department
• Hawthorne Police Department
• Hermosa Beach Police Department
• Huntington Park Police Department
• Lost Hills (Malibu) Station, LASD
• Manhattan Beach Police Department
• Metropolitan Detention Center (MDC)
• Michael D. Antonovich Antelope Valley Courthouse
• Montebello Police Department
• Monterey Park Police Department
• Palmdale Station, LASD*
• Pasadena Police Department
• Pitchess Detention Center, South LASD
• South Los Angeles Station, LASD*
• Topanga Police Department
• West Valley (Reseda), LAPD
• Whittier Police Department * Indicates the three stations that recently received an award from the Altus Global Al- liance, an international organization that promotes public safety and justice.
F2:
The following detention facilities were found to have programs worthy of commenda- tion and comment:
• Glendale Police Department (A39)1 This facility was highlighted in the CGJ 2009-10 Report, titled “Video-Conference Technology”. The video-arraignment procedure provided in The Glendale Police Department Station continues to be exemplary in 2011-2012. This arraignment process could be a model for LA County law enforcement agencies. The staff was willing and able to share information and expertise with other detention facili- ties. See Appendix A for identification codes. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 415
• Hawthorne Police Station (A42) The CGJ found the insight provided by one of the jailers especially valuable. That jailer, with many years of experience, applied his experience and wisdom as a valuable guide in the planning and general design of the configuration of the new Hawthorne Detention Facility.
• Lost Hills Sheriff’s Station (A59) The Lost Hills Sheriff’s Station is located in a high fire risk area. Presently, if there were a large fire and horses needed to be evacuated, they would be trans- ported to an equestrian facility at Pierce College in Woodland Hills for temporary protective housing. To extend the protection of animals, the Lost Hills Sheriff’s Station is currently building a kennel to house canines and felines should evac- uation be necessary for fire protection during future emergencies.
• Metropolitan Detention Center (A68) The Metropolitan Detention Center (MDC) is a new, state-of-the-art facility which opened in February 2011. It has modern equipment including electronic controls, an Automated External Defibrillator (AED) in most areas, and Policies and Pro- cedures online. It also has 24 hour medical services on site. The facility is well run and well maintained.
• Palmdale Station (A81) Palmdale Station is an exceptionally well run and maintained station located in a modern facility built in 2006. The entire operation of the facility and discipline re- flected in its operation reflect the ”Ethics Based” program initiated by the Los An- geles Sheriff’s Department. By all accounts and observable measures the program is excellent. This station is unique in its cooperation and proximity of location to other public service facili- ties. Palmdale General Hospital and Antelope Valley Hospital are both nearby. In addition, a fire station and an armory are closely positioned and would be used in the event of a major emergency. The station has received an international award for its exemplary and efficient “line-of-sight” design. Additionally and of particular note, three Los Angeles County Sheriff’s Department facilities earned international awards for its achievements as a “Citizen-Centric Organization”. To achieve that status, five core aspects of a police station and related services provided were scored. Those areas are community orientation, physical conditions, equal treatment of the public, transparency and accountability, and detention conditions. Palmdale Station was given the top award for its achievements. The award con- ference was hosted by the Altus Global Alliance, a group of six academic centers and non-governmental organizations on five continents which worked in partner- ship with government institutions to strengthen the delivery of public safety and justice. DETENTION COMMITTEE 416 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT The Los Angeles County Sheriff’s Department’s Palmdale Station, its personnel, and the Los Angeles County Sheriff’s Department deserve particular recognition from the CGJ for achieving this highest of honors from a recognized independent international organization.
• Pitchess Detention Center - South (A89) The CGJ found the Pitchess Detention Center continues to be a blueprint for success. The date of the CGJ site inspection coincided with the sixth graduation ceremony at the detention center. The graduation theme, “Best Foot Forward,” centered on an on-going LASD program known as “Maximizing Education Reaching Individual Transformation” (MERIT) program. It was found to be an exceptional program which provides hope, inspiration and guidance to soon-to- be-released inmates. The CGJ interfaced with a number of the inmates participating in the ceremony. Several inmates told the CGJ what the program meant to them. For instance, one inmate said he now has a sense of purpose, a new hope, and a commitment to changing his life. Other inmates expressed similar responses to the CGJ. The CGJ noted the great sense of camaraderie and spirit of the speakers expressed at the graduation. An all-inmate band called “The Contra Band” played inspira- tional songs, and provided “musical bookends” to the graduation ceremony.
• Whittier Police Department (A125) The Whittier Police Department (WPD) is a new, state-of-the-art police headquar- ters which opened October 26, 2010. There are a number of social services supporting agencies housed in the building. A “soft room” provides personal security and comfort for traumatized crime vic- tims. A children’s play room is filled with toys and children’s furniture. A Crime Analysis Unit, Crime Scene Investigation, and a Forensic Bureau are also locat- ed on the site. This collection of agencies provides technical support: evidence collecting, video taping, photography, development and comparison of finger- prints, and crime scene diagram construction. The WPD is one of nine police agencies in Los Angeles County designated as a Latent Input Terminal for the Los Angeles County Region Identification System where fingerprint comparison is done by forensic specialists. Testimony often re- lies upon this level of forensic evidence. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 417
F3:
Of the 16 Juvenile facilities CGJ visited, three (19%) were found to be exceptional based on educational programs, physical facilities, maintenance, inmate treatment, staff knowledge and background, and/or expressed commitment:
• Gonzales Youth Camp (Y18)2
• Scott Girls Camp (Y27)
• Scudder Girls Camp (Y28)
F4:
Several detention facilities were found to have specific areas of concern: Los Angeles Sheriff’s Department:
• Alhambra Courthouse (A2) has an open area where detainees are brought into the court on the 2nd floor. There are no secure holding cells where the detainees wait for court hearings on the 2nd floor, causing a potential risk to sheriffs or civil- ians.
• Avalon Station (A7) is an older station with some open wires hanging down in line of sight. The workstations are outdated. There is no video for surveillance of the station. The sobriety cell does not have a soft floor.
• Central Regional Detention Facility (A20) is a large facility where staff needs to be added as there are no funds for overtime. If someone is ill there are no funds for a replacement deputy for that period of time.
• East Los Angeles Station (A32) is a busy station with a sobering cell that needs a standard non-porous floor. The current flooring causes an unpleasant odor that permeates the area. The deputies in the jail use the same telephone line as the main station. The phone line is frequently busy, so they have difficulty com- municating with officers in cars transporting new detainees to the jail.
• Glendale Courthouse (A38) shares a parking lot for the delivery and return of inmates with a nearby public business facility, creating a potential safety risk to the public. The transportation of inmates typically occurs at the business facility’s most busy time. Furthermore, it can occur at dusk in the winter when visibility is obstructed. The barbed wire sally port is non-standard and contributes to a po- tential risk issue.
• Industry Station (A47) The visitation booth is inoperable and needs repair.
• Men’s Central Jail (A65) needs more safety bars in the shower area. There is a need for increased staffing for additional security.
• Mental Health Courthouse (A66) is located in an old manufacturing building that has been modified for use as a court. Mentally ill patients await court hear- ings in an open patio area adjacent to the general population.
• Metropolitan Traffic Courthouse (A67) lacks cameras and viewing monitors for security. The toilet facilities are porcelain and could be a safety issue.
• Pitchess Detention Center - East Facility (A87) is a jail housing a large num- ber of high-risk detainees. More supervision is necessary for the security of the station. See Appendix B for identification codes. DETENTION COMMITTEE 418 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
• Pitchess Detention Center - South Facility (A89) is a jail housing a large num- ber of high-risk detainees. More supervision is necessary for the security of the station. The facility lacks video monitoring in the barracks and dining room.
• Pitchess North - County Correctional Facility (A90) is a jail housing a large number of high-risk detainees. More supervision is necessary for the security of the station.
• Santa Clarita Valley Station (A 101) handles a large number of inmates and is understaffed with only one jailer. The jailer must take care of booking, and in ad- dition, jail maintenance. The jail was so dirty it had to be closed for a day in or- der to be commercially cleaned. The jail lacked a sally port, video surveillance equipment, and a soft floor in the sobering cell.
• Van Nuys (West) Court (A115) had only a digital copy of Policies and Proce- dures. They had no hard copy for easy reference. Los Angeles Police Department:
• Central Area Police Station (A18) is located in a large facility where arrestees are cuffed to benches while officers write reports prior to booking at MDC. There is only a small monitor for the Watch Commander’s use. In addition, the ar- restees have no designated restroom facilities, therefore public restrooms are used.
• Northeast (LA/Eagle Rock) Station (A76) typically holds arrestees in cells for only a few hours before sending them to MDC. CGJ observed an arrestee re- questing use of a restroom. Because there was no toilet in the jail cells, the of- ficer escorted the inmate to a restroom. As the arresting officer entered the cell, CGJ noticed that his weapon was holstered because there were no gun lockers located outside the jail cell area.
• Van Nuys Division Police Station (A116) had no sally port for transporting de- tainees. This causes a security issue. Alhambra Police Department
• Alhambra Police Station (A3) There is no secure area in the booking area be- tween the staff and detainees. Arcadia Police Department
• Arcadia Police Station (A6) has a sobering cell with a partial wall. Detainees are able to climb on the wall and break the sprinklers causing a slipping or flood- ing hazard. Bell Gardens Police Department
• Bell Gardens Police Station (A10) is located in an older building. The sobering cells have no soft padding, causing a hazard for the detainees. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 419 Los Angeles County Probation Department
• Challenger (Y12-14), Mendenhall (Y21), Munz (Y23), Scott (Y27), and Scud- der (Y28) Camps. These juvenile detention facilities are located in outlying areas and must frequently transport youth great distances for medical services to the Los Angeles County + USC Hospital. This causes a burden on the staffing at the juvenile facilities, and delays the treatment of the youth.
F5:
A large number of detention facilities share areas of concern: 3
• Many detention facilities were built at least 40 years ago. Most are functioning well despite needing major physical updates as some are in seriously compro- mised condition.
• A number of detention facilities have limited video equipment for surveillance of the inmates for supervision.
• Several of the jails need to upgrade or better maintain sobering cells’ soft flooring for the safety and security of inebriated detainees.
• Some of the facilities lack Automated External Defibrillators and the staff is often not trained in the use of the equipment.
• Approximately 16% inmates housed at Los Angeles County detention facilities have mental health issues which require additional services. (See 2011-2012 CGJ Medications for Inmates report.) Specialized and ongoing training is im- portant for the security of the facilities.
• Some safety gear, such as flashlights, hard hats, and other equipment used in earthquake or fire drills, is placed in obscure, unmarked locations in the facilities.
• Some detention facilities are under-staffed, based on CGJ’s observations. Appendix A identifies specific facilities. DETENTION COMMITTEE 420 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
21
Not linked to specific findings.
R1:
Alhambra Courthouse (A2)
• Provide secure holding cell for detainees awaiting court procedures on the 2nd floor.
R2:
Avalon Station (A7)
• Repair electrical wiring in the station.
• Improve ergonomics in workstations.
• Provide video surveillance in station.
• Provide soft floor in sobering cell.
R3:
Central Regional Detention Facility (A20)
• Increase staffing ratios to allow for overtime if necessary.
R4:
East Los Angeles Station (A32)
• Provide standard soft flooring in sobering cell.
• Provide jail with a dedicated telephone line.
R5:
Glendale Courthouse (A38)
• Arrange transportation so public does not share open area with inmates waiting for transportation.
• Address sally port for public and personnel safety.
R6:
Industry Station (A47)
• Repair visitation booth.
R7:
Men’s Central Jail (A65)
• Improve and increase number of grab bars in shower area.
• Increase staffing ratios to allow for overtime if necessary.
R8:
Mental Health Courthouse (A66)
• Remodel the facility as possible.
R9:
Metropolitan Traffic Courthouse (A66)
• Provide video equipment for security.
• Update toilets.
R10:
Pitchess Detention Center – East Facility (A87)
• Increase staffing for security. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 421
R11:
Pitchess Detention Center - South Facilities (A89)
• Increase staffing for security.
• Provide video surveillance in the barracks and dining rooms in the South facil- ity.
R12:
Pitchess Detention North-County Correctional Facility (A90)
• Increase staffing for security.
R13:
Santa Clarita Valley Station (A101)
• Provide soft flooring for sobering cells.
• Provide video equipment to monitor cells.
• Construct a sally port.
• Address staffing issues.
R14:
Van Nuys (West) Court (A115)
• Provide a printed copy of Policies and Procedures for staff use. Los Angeles Police Department
R15:
Central Area Police Station (A18)
• Provide designated toilet facilities for arrestees, or provide and post a protocol for use of the public rest room for arrestees.
• Update video monitor for security.
R16:
Northeast (LA Eagle Rock) Station (A76)
• Provide gun lockers for safety of officers entering detention cells.
• Provide toilet facilities for arrestees, or provide and post a protocol for use of the public restroom for arrestees.
R17:
Van Nuys Division Police Station (A116)
• Provide sally port. Alhambra Police Department
R18:
Alhambra Police Station (A3)
• Provide a secure area for booking process in the station. Arcadia Police Department
R19:
Arcadia Police Station (A6)
• Address the construction of the partial wall in the sobering cell. Bell Gardens Police Department
R20:
Bell Gardens Police Station (A10)
• Provide soft flooring in sobering cells. DETENTION COMMITTEE 422 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Los Angeles County Probation Department
R21:
Juvenile Detention Facilities: Challenger (Y12-14), Mendenhall (Y21), Munz (Y23), Scott (Y27) and Scudder (Y28)
• Negotiate and provide contracts with a local medical hospital or an appropri- ate facility for medical services. DETENTION COMMITTEE 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 423
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Findings & Recommendations
10 findings
F1:
Substitute teachers are frequently employed because of the year-round calendar and teachers’ training schedule. Students who leave the camp schools frequently return to local schools that are on the traditional calendar.
F2:
There is uneven educational use of computers and technology by students. Some students are very comfortable using computers to share research and reports, while other students have no opportunity to work on computers.
F3:
The academic program at The Road to Success Academy is highly acclaimed by teachers, students and probation officers at Scott and Scudder Camps. Project- based academic programs are more efficient for record keeping. Project-based academic programs engage the students in learning more intensely than traditional education.
F4:
Teachers at the juvenile camps and halls’ schools are appropriately credentialed by the State of California. However, teachers do not all have the same level of competence. Some teachers are allowed to continue to teach despite their inability to manage a classroom.
F5:
Students at some of the camps are transported long distances to LAC+USC Hospital for a number of medical procedures so they miss valuable class time.
F6:
Vocational education opportunities are limited at the camps due to scheduling challenges.
F7:
Mentors and volunteers provide a strong motivation to youth for inspiration and are excellent role models.
F8:
Juveniles benefit from additional leisure reading materials.
F9:
Probation officers play a very important role in support of education of students at the camps.
F10:
The CGJ saw no court officers at the camps. The CGJ was told by probation officers that they have not seen court officers visit the camps.
Additional Recommendations
10
Not linked to specific findings.
R1:
Address the situation of the frequent use of substitute teachers. Long- term substitutes must be trained with the regular teachers for continuity of the education program. Change to a traditional, September-June calendar, to parallel other districts in Los Angeles, with staff development occurring primarily during the DETAINEE EDUCATION 222 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT summer. Summer school could be provided for remedial and elective courses. This would give teachers, who prefer working year-round, an opportunity to do so.
R2:
Expand the use of computers and technology for students’ education, and provide technical support for teachers.
R3:
Have teachers observe classes at the Road to Success Academy, to better implement the reforms detailed in the CERC report to the Board of Supervisors.
R4:
Strengthen the teacher evaluation process by frequent well-documented observations and counseling for improvement. With these provisions, teachers who do not meet expectations could choose to leave for a more suitable position, or they could be removed from their teaching positions at the camps and halls. The Chief of the Los Angeles County Probation Department
R5:
Negotiate and provide a contract with local hospitals for inoculations and medical services so that juveniles are not absent from classes, and staff is not away from camp for extended periods of time. The Chief of the Los Angeles County Probation Department and The Superintendent of the Los Angeles County Office of Education
R6:
Address scheduling challenges of vocational education. Vocational education should be an integral part of the program at the camps.
R7:
Implement a program for volunteers at the camps. A dedicated coordinator position in LACOE, or at various juvenile detention sites, would expand the involvement of the community.
R8:
Provide soft-back leisure reading books to promote book clubs at the camps and to give to the students as they leave.
R9:
Form a task force to develop a process so that probation staff and teachers can communicate and work together in a more meaningful way.
R10:
Invite members of the juvenile court system to visit and observe the improved educational programs at the juvenile camps.
Findings & Recommendations
10 findings
F1:
Substitute teachers are frequently employed because of the year-round calendar and teachers’ training schedule. Students who leave the camp schools frequently return to local schools that are on the traditional calendar.
F2:
There is uneven educational use of computers and technology by students. Some students are very comfortable using computers to share research and reports, while other students have no opportunity to work on computers.
F3:
The academic program at The Road to Success Academy is highly acclaimed by teachers, students and probation officers at Scott and Scudder Camps. Project- based academic programs are more efficient for record keeping. Project-based academic programs engage the students in learning more intensely than traditional education.
F4:
Teachers at the juvenile camps and halls’ schools are appropriately credentialed by the State of California. However, teachers do not all have the same level of competence. Some teachers are allowed to continue to teach despite their inability to manage a classroom.
F5:
Students at some of the camps are transported long distances to LAC+USC Hospital for a number of medical procedures so they miss valuable class time.
F6:
Vocational education opportunities are limited at the camps due to scheduling challenges.
F7:
Mentors and volunteers provide a strong motivation to youth for inspiration and are excellent role models.
F8:
Juveniles benefit from additional leisure reading materials.
F9:
Probation officers play a very important role in support of education of students at the camps.
F10:
The CGJ saw no court officers at the camps. The CGJ was told by probation officers that they have not seen court officers visit the camps.
Additional Recommendations
10
Not linked to specific findings.
R1:
Address the situation of the frequent use of substitute teachers. Long- term substitutes must be trained with the regular teachers for continuity of the education program. Change to a traditional, September-June calendar, to parallel other districts in Los Angeles, with staff development occurring primarily during the DETAINEE EDUCATION 222 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT summer. Summer school could be provided for remedial and elective courses. This would give teachers, who prefer working year-round, an opportunity to do so.
R2:
Expand the use of computers and technology for students’ education, and provide technical support for teachers.
R3:
Have teachers observe classes at the Road to Success Academy, to better implement the reforms detailed in the CERC report to the Board of Supervisors.
R4:
Strengthen the teacher evaluation process by frequent well-documented observations and counseling for improvement. With these provisions, teachers who do not meet expectations could choose to leave for a more suitable position, or they could be removed from their teaching positions at the camps and halls. The Chief of the Los Angeles County Probation Department
R5:
Negotiate and provide a contract with local hospitals for inoculations and medical services so that juveniles are not absent from classes, and staff is not away from camp for extended periods of time. The Chief of the Los Angeles County Probation Department and The Superintendent of the Los Angeles County Office of Education
R6:
Address scheduling challenges of vocational education. Vocational education should be an integral part of the program at the camps.
R7:
Implement a program for volunteers at the camps. A dedicated coordinator position in LACOE, or at various juvenile detention sites, would expand the involvement of the community.
R8:
Provide soft-back leisure reading books to promote book clubs at the camps and to give to the students as they leave.
R9:
Form a task force to develop a process so that probation staff and teachers can communicate and work together in a more meaningful way.
R10:
Invite members of the juvenile court system to visit and observe the improved educational programs at the juvenile camps.
Findings & Recommendations
5 findings
F1:
The nonminor is completing secondary education or a program leading to an equivalent credential.
F2:
The nonminor is enrolled in an institution which provides postsecondary or vocational educational education.
F3:
The nonminor is participating in a program or activity designed to pro- mote, or remove barriers to employment.
F4:
MENTAL HEALTH SERVICES THROUGH DMH Multidisciplinary Assessment Teams (MATs) As part of the County of Los Angeles’ settlement agreement from the Katie A. lawsuit,10 the Department of Children and Family Services (DCFS) has made it a policy that all newly detained youth are required to receive a mental health screening or assessment and appropriate linkage to services in a timely manner. To accomplish this, DCFS and the Department of Mental Health (DMH) have collaborated to expand their Multidiscipli- nary Assessment Team (MAT) Assessment Program to all Service Planning Areas. However, this assessment occurs independent of the DCFS detention process, which includes the Initial Medical Exam and mental health screening at the Hub Clinics. Once detained by DCFS as a result of a court order, a youth is referred by staff for a multidisciplinary assessment, generally conducted by a DMH-contracted community- based organization called a MAT Provider. This assessment is intended to provide a comprehensive understanding of the complicated issues that families face when they first enter the foster care system and to enable DCFS Children’s Social Workers (CSWs) to determine more effectively 1) the appropriate placement for the youth; 2) services needed by the youth and their families; and 3) early diagnosis and intervention of critical medical, dental and mental health issues. The MAT Provider gathers information from various sources in the following key areas with regard to the youth and their family: 1) level of engagement; 2) family’s functioning; 3) family’s strengths and needs; 4) child’s functioning, including interpersonal, physical health, mental health, developmental, educational, and vocational functioning, if appli- cable; 5) child’s strengths and needs; 6) current placement; and 7) alternate place- ments, if applicable. For MAT sessions, interviews are conducted with the youth’s parents and/or caregivers and parent-child interactions are observed. A team is assembled to evaluate the find- ings from the interviews and plan for needed services. This team generally includes a mix of individuals involved with the case including: the caregiver; family members; the child, if appropriate; Children’s Social Worker (CSW); Public Health Nurse (PHN) and others concerned with the case. MAT Assessments and Hub Clinics Linkage between the MAT Assessments and Hub Clinics is very limited. The most direct linkage is through the use of the medical report from the Initial Medical Examinations at the Hub Clinics, but these reports are not always available or used in MAT Assess- 10 In July 2002, the “Katie A., et al. v. Diana Bontá" class-action lawsuit was filed against the State of California and the County of Los Angeles on behalf of five named plaintiff foster children and a class of children and young adults who are in the custody of DCFS, or have been referred to or are subject to being referred to DCFS. In lieu of mone- tary compensation, the Katie A. plaintiffs requested that the State and County improve upon its delivery of mental health services to children and families. http://www.lacdcfs.org/katieA/docs/Settlement%20Agreement.pdf EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 287 ments. For instance, youth referred for a MAT Assessment can obtain a medical report from either a Hub Clinic or a community provider. Although detained youth are mandat- ed by DCFS to obtain an Initial Medical Examination at one of the Hub Clinics, a sepa- rate DCFS policy on MAT Assessments contradicts this requirement by allowing the as- sessments to include medical exams from community providers. Secondly, per DCFS and DMH policy, the MAT Assessment must be completed within 30-45 days after acceptance of a referral. However, according to DMH management, though DCFS requires Initial Medical Examinations to be completed at the Hub Clinics within 30 days of initial placement, the actual timing of the Initial Medical Examinations does not always coincide with the 30-45 day requirement for the completion of the MAT Assessment. As discussed in Section 3 of this report, 22.9 percent of the referrals to the Hub Clinics in FY 2010-11 resulted in missed appointments. Because the findings of the MAT Assessment must be presented to the Court, the medical exam is often provided by a community provider. As previously mentioned, a MAT team consisting of various stakeholders and service providers is assembled to evaluate the detained youth’s condition and service needs. According to the Memorandum of Understanding between DCFS and DHS, one of the goals of the Hub Clinics is to “improve coordination and child health care outcomes.” Though their input could be valuable, particularly for youth with Special Health Care Needs,11 except for rare occasions, Hub Clinic staff do not participate in the MAT team meetings. Without the participation of medical Hub Clinic staff and PHNs in MAT team meetings, an opportunity is lost to improve coordination and integration of medical and other care in service plans. PHNs could serve as the critical link between the Hub Clinics and the MAT Assess- ments because of their understanding of medical issues and their responsibility to coun- sel CSWs on medical issues related to their cases. With the approval of additional Title IV-E Waiver funds for hiring PHNs to be co-located at the Hub Clinics, DCFS and DHS should include attending MAT Assessments as one of the prioritized responsibilities of these PHNs. Mental Health Screenings and Ongoing Mental Health Services An additional shared goal of the MAT Assessments conducted by MAT Providers and the Initial Medical Exams conducted at the Hub Clinics is to perform mental health screenings, identify mental health needs, and ensure linkage to additional services. Though there are shared goals in identifying mental health needs, the MAT Providers and the Hub Clinics were provided different mental health screening tools by DMH. In particular, the MAT Providers use a more in-depth screening tool. According to DMH management, the use of different mental health screening tools at the Hub Clinics is dic- 11 Special Health Care Needs is defined by DCFS Procedural Guide 0600-505.10 as: 1) a condition that can rapidly deteriorate resulting in permanent injury or death, or 2) a medical condition that requires specialized in-home health care. EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 288 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tated by the varying levels of expertise of the screeners at the Hubs. Inconsistent train- ing and the use of a different screening tool could potentially lead to: 1) inability to iden- tify mental health services that are needed or 2) referrals for mental health services that are not needed. Although DMH-contracted MAT Providers are able to provide MAT Assessments as well as ongoing mental health services, there is limited linkage between the MAT Providers and Hub Clinics for ongoing mental health services. There are 50 organizations in the County that contract with DMH to be MAT Providers and provide MAT Assessments and ongoing mental health services. In contrast, there are seven Hub Clinic locations and only two are affiliated with organizations that have contracts with DMH to be MAT Providers and ongoing mental health service providers: LAC+USC and Children’s Hos- pital. The East San Gabriel Valley Satellite Hub Clinic has access to mental health ser- vice providers through its affiliation with LAC+USC. Data on mental health screenings at the Hub Clinics in FY 2010-11 illustrates that as high as 80 percent of youth screened at the clinics have a positive result, indicating a need for additional mental health services. Without strong linkages to the DMH system, these youth are in danger of not receiving needed mental health services, violating the intent of the Katie A. Settlement. Table 4-1 below shows the number of mental health screenings and results across all Hub Clinics in FY 2010-11. Table 4-1. Number of Mental Health Screenings and Results (FY 2010-11) ESGV H-UCLA LAC+USC MLK OV-UCLA HD CHLA TOTAL # Screenings 1,184 1,713 6,244 1,537 1,051 1,238 466 13,433 # Positive Results 482 859 3,253 322 844 802 369 6,931 % Positive 41% 50% 52% 21% 80% 65% 79% 52% Source: DHS records System of Integration LAC+USC and Children’s Hospital are the only Hub Clinics that are able to provide mental health services simultaneously or immediately after an Initial Medical Examina- tion because they are both affiliated with larger organizations that contain separate mental health service divisions that are also DMH contractors. (The Violence Interven- tion Project is the parent non-profit organization for the LAC+USC Hub Clinic and the Children’s Hospital Hub Clinic is part of Children’s Hospital LA.) The East San Gabriel Valley Satellite has access to mental health providers through LAC+USC. The new Children’s Medical Village at LAC+USC, which is slated to begin operations in 2012, will also provide mental health services to its patients as part of its comprehensive, multi- disciplinary approach. Two other Hub Clinics are poised to provide more direct linkages to mental health ser- vices. Though they are not officially affiliated, the Martin Luther King, Jr. Hub Clinic is located in the same building as SHIELDS, a DMH contractor and MAT Provider, while the Harbor-UCLA Hub Clinic is located a few bungalows away from Children’s Institute, EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 289 also a DMH contractor and MAT Provider. To help the Hub Clinics ensure that linkage to ongoing mental health services occurs for their patients, DHS and DCFS should re- quire that each Hub Clinic establish contractual relationships with DMH contractors/MAT Providers to enable integrated mental health services at the clinics and documented as- surances that Hub Clinic patients are receiving needed mental health services from those contractors. The remaining two Hub Clinics, Olive View-UCLA and High Desert, do not have strong linkages to mental health providers at this time and currently do not have Clinical Psy- chologists on their staff. Olive View-UCLA Hub Clinic staff reported that they have lim- ited access to Clinical Psychologists staffed by the hospital for emergency cases only (i.e. suicidal youth) and are rarely able to follow up on youth referred for mental health services outside of the hospital. The youth screened at Olive View-UCLA and High De- sert could be receiving mental health assessments and services through other MAT Providers, but a stronger system should be established to coordinate the mental health screenings and services at the Hub Clinics to: 1) ensure that youth are receiving mental health services; and, 2) reduce any duplication of efforts. Development of a more integrated system and structure for the MAT Assessment, Initial Medical Examinations, and ongoing mental health services would require the collabora- tion of the directors of DCFS, DHS, and DMH, along with MAT Providers and Hub Clinic staff. While DMH management generally agrees with the concept of better integrating the Initial Medical Examination and MAT Assessment processes as well as ongoing treatment, Department representatives raised a concern about ensuring an even distri- bution of workload among MAT Providers. For example, a MAT Provider located in close proximity to a Hub Clinic, could end up with a higher volume of referrals for ser- vices as compared to other MAT Providers. DMH management noted that there is already an uneven distribution of workload among the MAT Providers because the distribution of funding to these contractors is based on where youth are detained, not where they are placed. For instance, a youth may begin the MAT Assessment Process in one service area, but must continue the Assessment or ongoing mental health services in another area because that is where he/she is placed. Even though DMH has a better understanding of the distribution of workload among the MAT Providers, DCFS is responsible for making referrals and MAT Providers respond to DCFS referrals on a first come, first served basis,. Therefore, in developing a more integrated system, DCFS, DHS, and DMH should con- sider developing agreements between the Hub Clinics and multiple MAT Providers in the same service area for one or more MAT Providers to provide office hours for mental health screenings/MAT Assessments and/or ongoing services at the Hub Clinics. This would allow multiple MAT Providers to each have a role in the provision of mental health services at the Hub Clinics as well as at other locations closer to the youth’s home or placement location. Further, DMH should consider alternative contracting options to bet- ter align services needed by DCFS youth and services actually provided by MAT Pro- viders, given that youth are placed in different areas throughout the County. Finally, EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 290 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT DMH and DCFS should have better oversight of the distribution of referrals and provi- sion of ongoing mental health services among MAT Providers. Mental Health Services for Youth Ages 0-5 and their Families Youth ages 0-5 are the most vulnerable population in the child welfare system. Accord- ing to DMH management, one desirable skill for MAT Providers, which could help en- sure the provision of mental health services to this target population, is the ability to identify the medical necessity of such services among the youth ages 0-5 and their par- ent(s). Identification of medical necessity is critical for ongoing treatment for mental health issues and is required for Medi-Cal reimbursement through State Early Periodic Screening, Diagnosis and Treatment (EPSDT) funds. Most of the child deaths among DCFS involved youth occur when they are placed in-home with their parents. A mental health service that could address the needs of youth ages 0-5 is collateral treatment, or mental health services provided to both the parent(s) and child. To ensure that this population receives the mental health services it needs, DMH should continue training MAT Providers so they are all able to adequately screen, assess, and provide treatment to youth ages 0-5, including: 1) sufficiently identifying medical neces- sity, and 2) appropriately providing collateral treatment for the parent(s) and child. In addition to training staff, DMH should provide more support for the trained staff to help prevent staff burnout, while dealing with the traumatic experiences of vulnerable youth ages 0-5. SUMMARY The Department of Children and Family Services (DCFS) has mandated that youth in the child welfare system receive mental health screening or assessment and appropri- ate linkage to mental health services in a timely manner, as part of the County’s Katie A. lawsuit settlement. However, DCFS has created two separate systems by which a de- tained youth can receive such services, the Multidisciplinary Assessment Team (MAT) Assessment Program through its collaboration with the Department of Mental Health (DMH) and the Initial Medical Examinations at the Hub Clinics through its Memorandum of Understanding with the Department of Health Services (DHS). The MAT Assessment process and the Initial Medical Examinations at the Hub Clinics may utilize separate sources of medical information for the assessment of a youth, sometimes have disjointed timelines, generally use different mental health screening tools, and have access to different providers for ongoing mental health services. Great- er linkage between the two processes is needed for Hub Clinics to: 1) ensure that youth are receiving mental health services and 2) reduce duplication of efforts. Such integra- tion should be developed by DCFS, DHS, and DMH, with input from MAT Providers and Hub Clinic staff. Additionally, a system or structure that provides greater integration should also take into consideration the distribution of referrals, assessments, and ongo- ing services among existing MAT Providers to allow for multiple providers to have op- portunities to provide services in coordination with the Hub Clinics. EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 291 According to DMH management, two skills among staff of MAT Providers that could help further address the mental health needs of youth ages 0-5 are the abilities to: 1) identify medical necessity for ongoing mental health services among youth ages 0-5, and 2) provide collateral treatment, i.e., treatment of both the parent(s) and child. DMH has conducted training in these areas for MAT Providers in the past. FINDINGS 4.1. Linkage between the Multidisciplinary Assessment Team (MAT) Assessments and Initial Medical Examinations at Hub Clinics is very limited, though both are required by DCFS for newly detained youth. For example, medical reports from the Hub Clinics are not always completed or sent in time to be included in the MAT As- sessments and Hub Clinic staff and Public Health Nurses do not participate in the MAT team meetings. 4.2. MAT Providers, i.e., community-based organizations contracted by DMH, and the Hub Clinics that are not MAT Providers, use different mental health screening tools, though the goal for both processes is to identify a youth’s mental health needs. 4.3. There is limited linkage between the DMH-contracted MAT Providers and Hub Clin- ics for providing ongoing mental health services to clinic patients. Divisions of the LAC+USC and Children’s Hospital Hub Clinics’ affiliated organizations contract with DMH as MAT Providers and provide such services; the Martin Luther King, Jr. and Harbor-UCLA Hub Clinics are in close proximity to MAT Providers, but their linkage to these providers is limited; and Olive View-UCLA and High Desert’s linkage to MAT Providers is not as strong as in the other Hub Clinics. 4.4. The Olive View-UCLA and High Desert Hub Clinics do not have any budgeted clin- ical psychologists on-site. 4.5. The distribution of referrals for MAT Assessments and ongoing mental health ser- vices from DCFS to DMH contract MAT Providers is uneven and is a concern by DMH management regarding the development of a more integrated system be- tween the MAT Assessments, Initial Medical Examinations, and ongoing mental health services. 4.6. Youth ages 0-5 and their parents and families could benefit from ongoing mental health services when medical necessity is appropriately identified and when they participate in collateral treatment, or therapy that includes the parent and child.
F5:
The nonminor is incapable of doing any of the activities described in sub- paragraphs (1) to (4), inclusive, due to a medical condition, and that inca- pability is supported by regularly updated information in the case plan of the nonminor. Based on data provided by DCFS, the total population in Los Angeles County eligible for extended foster care services due to AB 12 is estimated to be between 3,800 (16 and 17 year olds as of Nov. 30, 2011) to 5,483 (including those 18 and older as of Nov. 30, 2011). However, this estimate does not include Transition Age and eligible youth that may enter or exit the child welfare system up until 2014, the expected sunset date for AB 12 unless it is extended by the State legislature. Medical and mental health services for youth aged 18 years or older and under the ju- risdiction of DCFS have been limited. However, there are services offered by DMH that youth can continue to receive after they turn 18, independent of their status with DCFS. With the implementation of extended foster care services under AB 12, DCFS, DHS, and DMH should improve or create systems to address the specialized needs of youth aged 18 years or older. Medical Services for 18 Year Olds and Older Prior to the implementation of AB 12, DCFS provided youth aging out of the system with referral information on medical and mental health services and requirements for receiv- ing Medi-Cal under the Former Foster Care Children Program (FFCC) which allowed coverage until the age of 21. However, the former foster care youth would have to re- new their enrollment in Medi-Cal themselves, and DCFS management reported that not all of them were doing so. California Welfare and Institutions Code §11403(a) 18 California Welfare and Institutions Code §11403(b) EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 295 Since most Transition Age Youth are eligible for Medi-Cal coverage, they can obtain medical services from any Medi-Cal provider. There is no mandate or requirement for this population to go to a Hub Clinic. As a result, a majority of the Hub Clinics report serving very few youth aged 18 years or older. Medically Fragile/Vulnerable Youth who are medically fragile/vulnerable are those with special needs due to a mental health diagnosis, developmental delay or a physical or medical condition that requires specific care.19 As of November 30, 2011, there were 2,163 youth under the jurisdiction of DCFS identified as medically fragile/vulnerable, of which 198 were 18 years old or older. Within the medically fragile/vulnerable group, there is a subgroup of youth receiving DCFS services from the Medical Case Management Services (MCMS) Unit. These youth have special health care needs defined as: 1) a condition that can rapidly deterio- rate, resulting in permanent injury or death, or 2) a medical condition that requires spe- cialized in-home health care such as an enteral feeding tube, ventilator, intravenous therapy, or other medical or surgical procedures or special medication regiments.20 Youth under the supervision of the MCMS Unit require the most medical care and atten- tion of all the medically fragile/vulnerable youth under the jurisdiction of DCFS. The MCMS Unit works with families, caretakers, and the youth to ensure that the youth ob- tain the medical services they need. As of February 2012, there was a total of 580 youth under the MCMS Unit, of which 52 are 18 years old or older. The medical services for youth under the supervision of the MCMS Unit are funded through 1) Medi-Cal’s fee-for-service or managed care, depending on their enrollment; 2) California Children’s Services for special equipment such as wheelchairs and beds; and 3) Regional Centers21 for services such as occupational, physical and behavioral therapy. When youth under the supervision of the MCMS Unit turn 18, they may either remain under the supervision of the MCMS Unit because they are still in high school or the Courts have not terminated their DCFS cases due to severe health conditions. Medical- ly fragile/vulnerable youth over the age of 18 who are eligible for long-term Regional Center services are transitioned to service coordination by their local Regional Centers. If a youth does not fall under any of these categories, he/she could be emancipated and transitioned out of DCFS or any other supervision and oversight. DCFS Procedural Guide 0900-522.10 (Specialized Care Increment – D – Rate), DCFS Procedural Guide 0900- 522.11 (Specialized Care Increment – F – Rate). DCFS Procedural Guide 0600-505.10 (Assessments of and Services for Children with Special Health Care Needs) 21 Regional Centers are non-profit agencies under contract with the California Department of Developmental Services that help coordinate services needed because of a developmental disability. Depending on eligibility, most services offered at Regional Centers are free regardless of age or income. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 296 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Medically fragile/vulnerable youth aged 18 and older who do not remain with DCFS or who are not eligible for Regional Center services are at risk of abuse, isolation, home- lessness, neglect, or self-neglect. However, these youth are eligible for referrals to Adult Protective Services (APS) so that they may continue to have contact with social workers and access to needed services. It is unclear if all medically fragile/vulnerable youth ag- ing out of DCFS services are referred and transitioned to APS, when they are not eligi- ble for Regional Center services, but DCFS should strive to make such referrals when- ever possible. According to DCFS management, the medically fragile/vulnerable youth under the su- pervision of the MCMS Unit only access or interact with Hub Clinic staff when they are newly detained and require an Initial Medical Examination. These exams provide the medical history for the newly detained youth. However, continued medical services are obtained at specialized clinics across public and private hospitals throughout the Coun- ty. Although Hub Clinics may not offer the specialized services and clinics needed by the medically fragile/vulnerable youth under the MCMS Unit, the Hub Clinics can still play a role as the medical home for youth with multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. The Hub Clinics can also serve as the medical coordinators for the medically fragile/vulnerable Transition Age Youth who are 18 and older and have not transitioned to Regional Center services, such as an 18 year old who is diabetic and is in constant need of insulin shots. To serve as the medi- cal home, Hub Clinics would have to obtain and maintain all medical records for the pa- tient from multiple service providers within the hospital system affiliated with each Hub Clinic. Currently, DCFS staff coordinates services across multiple providers in different hospital systems for these youth, and should continue doing so for youth with medical providers across both County and private hospital systems. However, the specialized medical knowledge of Hub Clinic staff could facilitate the transfer of medical information more easily for medically fragile/vulnerable youth with specialists in the same hospital system. Ideally, youth aging out of DCFS would be transitioned to a program where they still have access to social workers and coordinated medical and mental health services ei- ther through a Regional Center, if developmentally disabled, or Adult Protective Ser- vices. For youth transitioned to Adult Protective Services, the Hub Clinics could com- plement the social services provided by coordinating the youth’s medical services. Mental Health Services for TAYs According to data provided by DMH, 3,904 DCFS youths with open DMH cases were aged 16 or older, representing 16.2 percent of the a total of 24,116 DCFS youths with open DMH cases. This also represents 71.2 percent of the 5,483 youth under the juris- diction of DCFS who were 16 years old or older as of November 30, 2011. These youths could have received DMH services through any number of DMH programs pro- EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 297 vided throughout the County including: 1) services provided through the Multidisciplinary Assessment Team (MAT) Assessment Program,22 2) Full Service Partnership Program (FSP),23 3) Assertive Community Treatment (ACT),24 and 4) Specialized Foster Care In- tensive In-Home Mental Health Services (IIHMHS),25 etc. Only two of the seven Hub Clinics, LAC+USC and Children’s Hospital, have contracts with DMH and have multiple mental health service professionals onsite. The East San Gabriel Valley Satellite Hub Clinic has access to mental health service providers through its affiliation with LAC+USC. Children’s Hospital is the only Hub Clinic that has services directed specifically toward Transition Age Youth. These are provided by the Children Hospital’s Division of Ado- lescent Medicine and located in a clinic separate from the CHLA Hub Clinic for younger children. Services for 12 to 21 year olds include specialized services for adolescents dealing with anger management, depression, substance abuse, homelessness, HIV and transgender issues. These services are provided to all adolescents, not just those re- ferred to the Hub Clinic by DCFS. Furthermore, LAC+USC hopes to obtain additional funding and resources to expand its Children’s Medical Village to include service for adults. This would require staffing the Medical Village with providers who are trained in both pediatrics and adult medicine, similar to the staff at the Children’s Hospital Division of Adolescent Medicine. Further, LAC+USC hopes to include Adult Protective Services staff in its proposed expanded Medical Village to provide easy access to social work services while remaining the med- ical home and coordinator of medical and mental health services for medically frag- ile/vulnerable Transition Age Youth aged 18 and older. Targeted Medical and Mental Health Services for Transition Age Youth As discussed in Section 1 of this report, “The Model Medical Hub Clinic”, model Hub Clinics should serve as the medical home and provide onsite mental health services for youth under the jurisdiction of DCFS. With the implementation of AB 12, youth aged 18 years old and older will continue to be eligible for medical and mental health services at Hub Clinics. At this time, Children’s Hospital is the only Hub Clinic that is able to pro- vide both medical and mental health services that are targeted toward the issues and 22 The Multidisciplinary Assessment Team (MAT) Assessment Program provides comprehensive assessments to evaluate a foster youth’s needs and strengths in various areas including medical, dental, developmental, hear- ing/language, education, mental health, vocational, and family/caregiver issues. The Transition Age Youth Full Service Partnership Program offers intensive services with 24/7 staff availability to help 16 to 25 year olds address emotional, housing, physical health, transportation, and other needs to help them function independently in the community. Assertive Community Treatment is a team-based approach to the provision of treatment, rehabilitation, and support services. A variety of services are offered under the Specialized Foster Care Intensive In-Home Mental Health Services (IIHMHS) program, including 24/7 intensive case management, Trauma Focused Cognitive Behavioral Therapy, Functional Family Therapy, as well as programs to assist caregivers with behavioral and emotional problems in young children. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 298 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT concerns of youth 18 years old and older. Therefore, DCFS should encourage youth 18 years old and older with complex medical and/or mental health needs to go to the Chil- dren’s Hospital services. According to Children’s Hospital staff, should referrals to the adolescent clinic from DCFS increase, the clinic would then consider applying for Federally Qualified Health Center (FQHC) status, which would allow the clinic to receive greater reimbursement for costs than they currently receive through Medi-Cal. However, until the adolescent clinic officially receives such a status, the clinic will need grant funding to absorb the addition- al referrals. Children’s Hospital is not conveniently located for all Transition Age Youth located throughout the County, particularly for the medically fragile/vulnerable youth aged 18 and older. DCFS, DHS, and DMH should work together to identify funding for additional transportation services to and from CHLA. Currently, Children’s Hospital is able to pro- vide transportation passes to youth participating in its Full Service Partnership Program, funded through a DMH contract. Similar funding should be identified or expanded for the additional DCFS referrals of youth to the Children’s Hospital. For youth who are not lo- cated near public transportation, DCFS, DHS, and DMH should explore funding for van services. This type of service is already provided to youth living in the Lancas- ter/Palmdale area for services at the High Desert Hub Clinic. Children’s Hospital currently has the greatest capacity to serve the special needs of Transition Age Youth aged 18 and older. Additionally, resources could be designated or reassigned to LAC+USC to expand its Children’s Medical Village to include medical services for adults and access to Adult Protective Services social workers to meet the medical and mental health needs of Transition Age Youth aged 18 and older. SUMMARY Prior to January 1, 2012, most youth under the jurisdiction of DCFS were emancipated and their DCFS cases were terminated after they turned 18 years old. Though there were exceptions for some 18 year olds to remain under foster care and receive inten- sive case management services, a majority of the youth 18 years old or older received additional DCFS services on a voluntary basis but did not access medical and mental health services at the Hub Clinics. Though most of these youth were eligible for Medi- Cal after they turned 18, which could reimburse the Hub Clinics if used by the youth, their choice of medical provider was left up to them. None of the County-affiliated Hub Clinics made special efforts to encourage these youth to obtain medical care from them. With the passage of extended foster care services through AB 12, as of January 1, 2012, youth under the jurisdiction of DCFS can remain in the child welfare system until the age of 21, as long as they meet certain criteria. Therefore, Transition Age Youth aged 18 to 21 could continue to use Hub Clinics for medical and mental health needs. Their medical care would continue to be reimbursed under the Medi-Cal fee-for-service arrangement, which provides a better cost recovery for the clinics than Medi-Cal man- aged care rates. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 299 A majority of the Hub Clinics currently do not provide medical services to youth under the jurisdiction of DCFS that are 18 years old or older. Youth that are medically frag- ile/vulnerable currently receive medical services from specialized medical providers and clinics throughout the County. Further, only two of the Hub Clinics have Department of Mental Health contracts and multiple mental health providers at their Hub Clinics to pro- vide mental health services to DCFS youth. Only Children’s Hospital LA offers an ado- lescent clinic that provides medical and mental health services targeted toward youth aged 12 to 21. However, LAC+USC has plans to expand its Children’s Medical Village with medical services for adults, particularly Transition Age Youth aged 18 and older, including access to Adult Protective Services social workers. The Hub Clinics could serve as medical homes for medically fragile/vulnerable TAYs by coordinating services among the various specialized medical and mental health provid- ers, as long as they are within the same hospital system. Such coordination would re- quire additional training for the medical providers to be aware of the various issues spe- cific to TAYs. Finally, DCFS and DHS could refer other medically fragile/vulnerable TAYs to Children’s Hospital to benefit from their specialized Adolescent Clinic and initi- ate a plan to establish similar specialty clinics for TAYs at some or all of the County Hub Clinics. The Hub Clinic with the greatest capacity for expansion of services for Transi- tion Age Youth is currently LAC+USC because it is building a Children’s Medical Village with an aim to provide access to subspecialty medical services beginning in the summer of 2012. FINDINGS 5.1. According to national statistics, youth transitioning out of foster care are at risk and have higher rates of homelessness, as well as mental health, physical, and devel- opmental problems. For example, 27 percent of the nation’s homeless population have been in foster care, while youth emancipating out of foster care have a one in six chance of being homeless within one year. 5.2. As of November 30, 2011, there were 1,672 youth under the jurisdiction of DCFS that were 18 or older. Prior to January 1, 2012, most of these youth were emanci- pated and their DCFS cases were terminated after they turned 18 years old. Most of these youth were only able to receive additional DCFS services on a voluntary basis and, though not precluded from doing so, most did not access medical and mental health services at the Hub Clinics which are generally geared toward chil- dren, and have not made efforts to encourage Transition Age Youth emancipating from the child welfare system to use their services. 5.3. With the passage of extended foster care services through AB 12, youth under the jurisdiction of DCFS may now remain in the child welfare system until the age of 21, as long as they meet certain criteria. Based on DCFS data on youth 16 years old and older and under DCFS jurisdiction as of November, 30, 2011, the estimat- ed total number of Transition Age Youth that could remain in DCFS through 2014 ranges from 3,800 to 5,483 youth. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 300 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 5.4. The number of medically fragile/vulnerable youth with special needs due to a men- tal health diagnosis, developmental delay or a physical or medical condition that requires specific care under the jurisdiction of DCFS was 2,163 as of November 30, 2011, of which 198 were 18 years old or older. Though Hub Clinics may not of- fer the specialized services and clinics needed by the medically fragile/vulnerable youth, the Hub Clinics can still play a role as the medical homes for youth who need to see multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. 5.5. The majority of the Hub Clinics currently do not provide medical services to youth aged 18 years old or older. Further, only two of the Hub Clinics have Department of Health contracts and multiple mental health providers onsite at their Hub Clinics to provide mental health services to DCFS youth. Only Children’s Hospital LA current- ly offers an adolescent clinic that provides medical and mental health services tar- geted toward youth age 12 to 21 years old. However, LAC+USC has plans to ex- pand its Children’s Medical Village, which will provide access to several medical subspecialty services, to include adult medical services for Transition Age Youth aged 18 or older.
Additional Recommendations
1
Not linked to specific findings.
R30-45:
days after acceptance of a referral. However, according to DMH management, though DCFS requires Initial Medical Examinations to be completed at the Hub Clinics within 30 days of initial placement, the actual timing of the Initial Medical Examinations does not always coincide with the 30-45 day requirement for the completion of the MAT Assessment. As discussed in Section 3 of this report, 22.9 percent of the referrals to the Hub Clinics in FY 2010-11 resulted in missed appointments. Because the findings of the MAT Assessment must be presented to the Court, the medical exam is often provided by a community provider. As previously mentioned, a MAT team consisting of various stakeholders and service providers is assembled to evaluate the detained youth’s condition and service needs. According to the Memorandum of Understanding between DCFS and DHS, one of the goals of the Hub Clinics is to “improve coordination and child health care outcomes.” Though their input could be valuable, particularly for youth with Special Health Care Needs,11 except for rare occasions, Hub Clinic staff do not participate in the MAT team meetings. Without the participation of medical Hub Clinic staff and PHNs in MAT team meetings, an opportunity is lost to improve coordination and integration of medical and other care in service plans. PHNs could serve as the critical link between the Hub Clinics and the MAT Assess- ments because of their understanding of medical issues and their responsibility to coun- sel CSWs on medical issues related to their cases. With the approval of additional Title IV-E Waiver funds for hiring PHNs to be co-located at the Hub Clinics, DCFS and DHS should include attending MAT Assessments as one of the prioritized responsibilities of these PHNs. Mental Health Screenings and Ongoing Mental Health Services An additional shared goal of the MAT Assessments conducted by MAT Providers and the Initial Medical Exams conducted at the Hub Clinics is to perform mental health screenings, identify mental health needs, and ensure linkage to additional services. Though there are shared goals in identifying mental health needs, the MAT Providers and the Hub Clinics were provided different mental health screening tools by DMH. In particular, the MAT Providers use a more in-depth screening tool. According to DMH management, the use of different mental health screening tools at the Hub Clinics is dic-
Findings & Recommendations
5 findings
F1:
The nonminor is completing secondary education or a program leading to an equivalent credential.
F2:
The nonminor is enrolled in an institution which provides postsecondary or vocational educational education.
F3:
The nonminor is participating in a program or activity designed to pro- mote, or remove barriers to employment.
F4:
MENTAL HEALTH SERVICES THROUGH DMH Multidisciplinary Assessment Teams (MATs) As part of the County of Los Angeles’ settlement agreement from the Katie A. lawsuit,10 the Department of Children and Family Services (DCFS) has made it a policy that all newly detained youth are required to receive a mental health screening or assessment and appropriate linkage to services in a timely manner. To accomplish this, DCFS and the Department of Mental Health (DMH) have collaborated to expand their Multidiscipli- nary Assessment Team (MAT) Assessment Program to all Service Planning Areas. However, this assessment occurs independent of the DCFS detention process, which includes the Initial Medical Exam and mental health screening at the Hub Clinics. Once detained by DCFS as a result of a court order, a youth is referred by staff for a multidisciplinary assessment, generally conducted by a DMH-contracted community- based organization called a MAT Provider. This assessment is intended to provide a comprehensive understanding of the complicated issues that families face when they first enter the foster care system and to enable DCFS Children’s Social Workers (CSWs) to determine more effectively 1) the appropriate placement for the youth; 2) services needed by the youth and their families; and 3) early diagnosis and intervention of critical medical, dental and mental health issues. The MAT Provider gathers information from various sources in the following key areas with regard to the youth and their family: 1) level of engagement; 2) family’s functioning; 3) family’s strengths and needs; 4) child’s functioning, including interpersonal, physical health, mental health, developmental, educational, and vocational functioning, if appli- cable; 5) child’s strengths and needs; 6) current placement; and 7) alternate place- ments, if applicable. For MAT sessions, interviews are conducted with the youth’s parents and/or caregivers and parent-child interactions are observed. A team is assembled to evaluate the find- ings from the interviews and plan for needed services. This team generally includes a mix of individuals involved with the case including: the caregiver; family members; the child, if appropriate; Children’s Social Worker (CSW); Public Health Nurse (PHN) and others concerned with the case. MAT Assessments and Hub Clinics Linkage between the MAT Assessments and Hub Clinics is very limited. The most direct linkage is through the use of the medical report from the Initial Medical Examinations at the Hub Clinics, but these reports are not always available or used in MAT Assess- 10 In July 2002, the “Katie A., et al. v. Diana Bontá" class-action lawsuit was filed against the State of California and the County of Los Angeles on behalf of five named plaintiff foster children and a class of children and young adults who are in the custody of DCFS, or have been referred to or are subject to being referred to DCFS. In lieu of mone- tary compensation, the Katie A. plaintiffs requested that the State and County improve upon its delivery of mental health services to children and families. http://www.lacdcfs.org/katieA/docs/Settlement%20Agreement.pdf EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 287 ments. For instance, youth referred for a MAT Assessment can obtain a medical report from either a Hub Clinic or a community provider. Although detained youth are mandat- ed by DCFS to obtain an Initial Medical Examination at one of the Hub Clinics, a sepa- rate DCFS policy on MAT Assessments contradicts this requirement by allowing the as- sessments to include medical exams from community providers. Secondly, per DCFS and DMH policy, the MAT Assessment must be completed within 30-45 days after acceptance of a referral. However, according to DMH management, though DCFS requires Initial Medical Examinations to be completed at the Hub Clinics within 30 days of initial placement, the actual timing of the Initial Medical Examinations does not always coincide with the 30-45 day requirement for the completion of the MAT Assessment. As discussed in Section 3 of this report, 22.9 percent of the referrals to the Hub Clinics in FY 2010-11 resulted in missed appointments. Because the findings of the MAT Assessment must be presented to the Court, the medical exam is often provided by a community provider. As previously mentioned, a MAT team consisting of various stakeholders and service providers is assembled to evaluate the detained youth’s condition and service needs. According to the Memorandum of Understanding between DCFS and DHS, one of the goals of the Hub Clinics is to “improve coordination and child health care outcomes.” Though their input could be valuable, particularly for youth with Special Health Care Needs,11 except for rare occasions, Hub Clinic staff do not participate in the MAT team meetings. Without the participation of medical Hub Clinic staff and PHNs in MAT team meetings, an opportunity is lost to improve coordination and integration of medical and other care in service plans. PHNs could serve as the critical link between the Hub Clinics and the MAT Assess- ments because of their understanding of medical issues and their responsibility to coun- sel CSWs on medical issues related to their cases. With the approval of additional Title IV-E Waiver funds for hiring PHNs to be co-located at the Hub Clinics, DCFS and DHS should include attending MAT Assessments as one of the prioritized responsibilities of these PHNs. Mental Health Screenings and Ongoing Mental Health Services An additional shared goal of the MAT Assessments conducted by MAT Providers and the Initial Medical Exams conducted at the Hub Clinics is to perform mental health screenings, identify mental health needs, and ensure linkage to additional services. Though there are shared goals in identifying mental health needs, the MAT Providers and the Hub Clinics were provided different mental health screening tools by DMH. In particular, the MAT Providers use a more in-depth screening tool. According to DMH management, the use of different mental health screening tools at the Hub Clinics is dic- 11 Special Health Care Needs is defined by DCFS Procedural Guide 0600-505.10 as: 1) a condition that can rapidly deteriorate resulting in permanent injury or death, or 2) a medical condition that requires specialized in-home health care. EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 288 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tated by the varying levels of expertise of the screeners at the Hubs. Inconsistent train- ing and the use of a different screening tool could potentially lead to: 1) inability to iden- tify mental health services that are needed or 2) referrals for mental health services that are not needed. Although DMH-contracted MAT Providers are able to provide MAT Assessments as well as ongoing mental health services, there is limited linkage between the MAT Providers and Hub Clinics for ongoing mental health services. There are 50 organizations in the County that contract with DMH to be MAT Providers and provide MAT Assessments and ongoing mental health services. In contrast, there are seven Hub Clinic locations and only two are affiliated with organizations that have contracts with DMH to be MAT Providers and ongoing mental health service providers: LAC+USC and Children’s Hos- pital. The East San Gabriel Valley Satellite Hub Clinic has access to mental health ser- vice providers through its affiliation with LAC+USC. Data on mental health screenings at the Hub Clinics in FY 2010-11 illustrates that as high as 80 percent of youth screened at the clinics have a positive result, indicating a need for additional mental health services. Without strong linkages to the DMH system, these youth are in danger of not receiving needed mental health services, violating the intent of the Katie A. Settlement. Table 4-1 below shows the number of mental health screenings and results across all Hub Clinics in FY 2010-11. Table 4-1. Number of Mental Health Screenings and Results (FY 2010-11) ESGV H-UCLA LAC+USC MLK OV-UCLA HD CHLA TOTAL # Screenings 1,184 1,713 6,244 1,537 1,051 1,238 466 13,433 # Positive Results 482 859 3,253 322 844 802 369 6,931 % Positive 41% 50% 52% 21% 80% 65% 79% 52% Source: DHS records System of Integration LAC+USC and Children’s Hospital are the only Hub Clinics that are able to provide mental health services simultaneously or immediately after an Initial Medical Examina- tion because they are both affiliated with larger organizations that contain separate mental health service divisions that are also DMH contractors. (The Violence Interven- tion Project is the parent non-profit organization for the LAC+USC Hub Clinic and the Children’s Hospital Hub Clinic is part of Children’s Hospital LA.) The East San Gabriel Valley Satellite has access to mental health providers through LAC+USC. The new Children’s Medical Village at LAC+USC, which is slated to begin operations in 2012, will also provide mental health services to its patients as part of its comprehensive, multi- disciplinary approach. Two other Hub Clinics are poised to provide more direct linkages to mental health ser- vices. Though they are not officially affiliated, the Martin Luther King, Jr. Hub Clinic is located in the same building as SHIELDS, a DMH contractor and MAT Provider, while the Harbor-UCLA Hub Clinic is located a few bungalows away from Children’s Institute, EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 289 also a DMH contractor and MAT Provider. To help the Hub Clinics ensure that linkage to ongoing mental health services occurs for their patients, DHS and DCFS should re- quire that each Hub Clinic establish contractual relationships with DMH contractors/MAT Providers to enable integrated mental health services at the clinics and documented as- surances that Hub Clinic patients are receiving needed mental health services from those contractors. The remaining two Hub Clinics, Olive View-UCLA and High Desert, do not have strong linkages to mental health providers at this time and currently do not have Clinical Psy- chologists on their staff. Olive View-UCLA Hub Clinic staff reported that they have lim- ited access to Clinical Psychologists staffed by the hospital for emergency cases only (i.e. suicidal youth) and are rarely able to follow up on youth referred for mental health services outside of the hospital. The youth screened at Olive View-UCLA and High De- sert could be receiving mental health assessments and services through other MAT Providers, but a stronger system should be established to coordinate the mental health screenings and services at the Hub Clinics to: 1) ensure that youth are receiving mental health services; and, 2) reduce any duplication of efforts. Development of a more integrated system and structure for the MAT Assessment, Initial Medical Examinations, and ongoing mental health services would require the collabora- tion of the directors of DCFS, DHS, and DMH, along with MAT Providers and Hub Clinic staff. While DMH management generally agrees with the concept of better integrating the Initial Medical Examination and MAT Assessment processes as well as ongoing treatment, Department representatives raised a concern about ensuring an even distri- bution of workload among MAT Providers. For example, a MAT Provider located in close proximity to a Hub Clinic, could end up with a higher volume of referrals for ser- vices as compared to other MAT Providers. DMH management noted that there is already an uneven distribution of workload among the MAT Providers because the distribution of funding to these contractors is based on where youth are detained, not where they are placed. For instance, a youth may begin the MAT Assessment Process in one service area, but must continue the Assessment or ongoing mental health services in another area because that is where he/she is placed. Even though DMH has a better understanding of the distribution of workload among the MAT Providers, DCFS is responsible for making referrals and MAT Providers respond to DCFS referrals on a first come, first served basis,. Therefore, in developing a more integrated system, DCFS, DHS, and DMH should con- sider developing agreements between the Hub Clinics and multiple MAT Providers in the same service area for one or more MAT Providers to provide office hours for mental health screenings/MAT Assessments and/or ongoing services at the Hub Clinics. This would allow multiple MAT Providers to each have a role in the provision of mental health services at the Hub Clinics as well as at other locations closer to the youth’s home or placement location. Further, DMH should consider alternative contracting options to bet- ter align services needed by DCFS youth and services actually provided by MAT Pro- viders, given that youth are placed in different areas throughout the County. Finally, EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 290 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT DMH and DCFS should have better oversight of the distribution of referrals and provi- sion of ongoing mental health services among MAT Providers. Mental Health Services for Youth Ages 0-5 and their Families Youth ages 0-5 are the most vulnerable population in the child welfare system. Accord- ing to DMH management, one desirable skill for MAT Providers, which could help en- sure the provision of mental health services to this target population, is the ability to identify the medical necessity of such services among the youth ages 0-5 and their par- ent(s). Identification of medical necessity is critical for ongoing treatment for mental health issues and is required for Medi-Cal reimbursement through State Early Periodic Screening, Diagnosis and Treatment (EPSDT) funds. Most of the child deaths among DCFS involved youth occur when they are placed in-home with their parents. A mental health service that could address the needs of youth ages 0-5 is collateral treatment, or mental health services provided to both the parent(s) and child. To ensure that this population receives the mental health services it needs, DMH should continue training MAT Providers so they are all able to adequately screen, assess, and provide treatment to youth ages 0-5, including: 1) sufficiently identifying medical neces- sity, and 2) appropriately providing collateral treatment for the parent(s) and child. In addition to training staff, DMH should provide more support for the trained staff to help prevent staff burnout, while dealing with the traumatic experiences of vulnerable youth ages 0-5. SUMMARY The Department of Children and Family Services (DCFS) has mandated that youth in the child welfare system receive mental health screening or assessment and appropri- ate linkage to mental health services in a timely manner, as part of the County’s Katie A. lawsuit settlement. However, DCFS has created two separate systems by which a de- tained youth can receive such services, the Multidisciplinary Assessment Team (MAT) Assessment Program through its collaboration with the Department of Mental Health (DMH) and the Initial Medical Examinations at the Hub Clinics through its Memorandum of Understanding with the Department of Health Services (DHS). The MAT Assessment process and the Initial Medical Examinations at the Hub Clinics may utilize separate sources of medical information for the assessment of a youth, sometimes have disjointed timelines, generally use different mental health screening tools, and have access to different providers for ongoing mental health services. Great- er linkage between the two processes is needed for Hub Clinics to: 1) ensure that youth are receiving mental health services and 2) reduce duplication of efforts. Such integra- tion should be developed by DCFS, DHS, and DMH, with input from MAT Providers and Hub Clinic staff. Additionally, a system or structure that provides greater integration should also take into consideration the distribution of referrals, assessments, and ongo- ing services among existing MAT Providers to allow for multiple providers to have op- portunities to provide services in coordination with the Hub Clinics. EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 291 According to DMH management, two skills among staff of MAT Providers that could help further address the mental health needs of youth ages 0-5 are the abilities to: 1) identify medical necessity for ongoing mental health services among youth ages 0-5, and 2) provide collateral treatment, i.e., treatment of both the parent(s) and child. DMH has conducted training in these areas for MAT Providers in the past. FINDINGS 4.1. Linkage between the Multidisciplinary Assessment Team (MAT) Assessments and Initial Medical Examinations at Hub Clinics is very limited, though both are required by DCFS for newly detained youth. For example, medical reports from the Hub Clinics are not always completed or sent in time to be included in the MAT As- sessments and Hub Clinic staff and Public Health Nurses do not participate in the MAT team meetings. 4.2. MAT Providers, i.e., community-based organizations contracted by DMH, and the Hub Clinics that are not MAT Providers, use different mental health screening tools, though the goal for both processes is to identify a youth’s mental health needs. 4.3. There is limited linkage between the DMH-contracted MAT Providers and Hub Clin- ics for providing ongoing mental health services to clinic patients. Divisions of the LAC+USC and Children’s Hospital Hub Clinics’ affiliated organizations contract with DMH as MAT Providers and provide such services; the Martin Luther King, Jr. and Harbor-UCLA Hub Clinics are in close proximity to MAT Providers, but their linkage to these providers is limited; and Olive View-UCLA and High Desert’s linkage to MAT Providers is not as strong as in the other Hub Clinics. 4.4. The Olive View-UCLA and High Desert Hub Clinics do not have any budgeted clin- ical psychologists on-site. 4.5. The distribution of referrals for MAT Assessments and ongoing mental health ser- vices from DCFS to DMH contract MAT Providers is uneven and is a concern by DMH management regarding the development of a more integrated system be- tween the MAT Assessments, Initial Medical Examinations, and ongoing mental health services. 4.6. Youth ages 0-5 and their parents and families could benefit from ongoing mental health services when medical necessity is appropriately identified and when they participate in collateral treatment, or therapy that includes the parent and child.
F5:
The nonminor is incapable of doing any of the activities described in sub- paragraphs (1) to (4), inclusive, due to a medical condition, and that inca- pability is supported by regularly updated information in the case plan of the nonminor. Based on data provided by DCFS, the total population in Los Angeles County eligible for extended foster care services due to AB 12 is estimated to be between 3,800 (16 and 17 year olds as of Nov. 30, 2011) to 5,483 (including those 18 and older as of Nov. 30, 2011). However, this estimate does not include Transition Age and eligible youth that may enter or exit the child welfare system up until 2014, the expected sunset date for AB 12 unless it is extended by the State legislature. Medical and mental health services for youth aged 18 years or older and under the ju- risdiction of DCFS have been limited. However, there are services offered by DMH that youth can continue to receive after they turn 18, independent of their status with DCFS. With the implementation of extended foster care services under AB 12, DCFS, DHS, and DMH should improve or create systems to address the specialized needs of youth aged 18 years or older. Medical Services for 18 Year Olds and Older Prior to the implementation of AB 12, DCFS provided youth aging out of the system with referral information on medical and mental health services and requirements for receiv- ing Medi-Cal under the Former Foster Care Children Program (FFCC) which allowed coverage until the age of 21. However, the former foster care youth would have to re- new their enrollment in Medi-Cal themselves, and DCFS management reported that not all of them were doing so. California Welfare and Institutions Code §11403(a) 18 California Welfare and Institutions Code §11403(b) EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 295 Since most Transition Age Youth are eligible for Medi-Cal coverage, they can obtain medical services from any Medi-Cal provider. There is no mandate or requirement for this population to go to a Hub Clinic. As a result, a majority of the Hub Clinics report serving very few youth aged 18 years or older. Medically Fragile/Vulnerable Youth who are medically fragile/vulnerable are those with special needs due to a mental health diagnosis, developmental delay or a physical or medical condition that requires specific care.19 As of November 30, 2011, there were 2,163 youth under the jurisdiction of DCFS identified as medically fragile/vulnerable, of which 198 were 18 years old or older. Within the medically fragile/vulnerable group, there is a subgroup of youth receiving DCFS services from the Medical Case Management Services (MCMS) Unit. These youth have special health care needs defined as: 1) a condition that can rapidly deterio- rate, resulting in permanent injury or death, or 2) a medical condition that requires spe- cialized in-home health care such as an enteral feeding tube, ventilator, intravenous therapy, or other medical or surgical procedures or special medication regiments.20 Youth under the supervision of the MCMS Unit require the most medical care and atten- tion of all the medically fragile/vulnerable youth under the jurisdiction of DCFS. The MCMS Unit works with families, caretakers, and the youth to ensure that the youth ob- tain the medical services they need. As of February 2012, there was a total of 580 youth under the MCMS Unit, of which 52 are 18 years old or older. The medical services for youth under the supervision of the MCMS Unit are funded through 1) Medi-Cal’s fee-for-service or managed care, depending on their enrollment; 2) California Children’s Services for special equipment such as wheelchairs and beds; and 3) Regional Centers21 for services such as occupational, physical and behavioral therapy. When youth under the supervision of the MCMS Unit turn 18, they may either remain under the supervision of the MCMS Unit because they are still in high school or the Courts have not terminated their DCFS cases due to severe health conditions. Medical- ly fragile/vulnerable youth over the age of 18 who are eligible for long-term Regional Center services are transitioned to service coordination by their local Regional Centers. If a youth does not fall under any of these categories, he/she could be emancipated and transitioned out of DCFS or any other supervision and oversight. DCFS Procedural Guide 0900-522.10 (Specialized Care Increment – D – Rate), DCFS Procedural Guide 0900- 522.11 (Specialized Care Increment – F – Rate). DCFS Procedural Guide 0600-505.10 (Assessments of and Services for Children with Special Health Care Needs) 21 Regional Centers are non-profit agencies under contract with the California Department of Developmental Services that help coordinate services needed because of a developmental disability. Depending on eligibility, most services offered at Regional Centers are free regardless of age or income. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 296 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Medically fragile/vulnerable youth aged 18 and older who do not remain with DCFS or who are not eligible for Regional Center services are at risk of abuse, isolation, home- lessness, neglect, or self-neglect. However, these youth are eligible for referrals to Adult Protective Services (APS) so that they may continue to have contact with social workers and access to needed services. It is unclear if all medically fragile/vulnerable youth ag- ing out of DCFS services are referred and transitioned to APS, when they are not eligi- ble for Regional Center services, but DCFS should strive to make such referrals when- ever possible. According to DCFS management, the medically fragile/vulnerable youth under the su- pervision of the MCMS Unit only access or interact with Hub Clinic staff when they are newly detained and require an Initial Medical Examination. These exams provide the medical history for the newly detained youth. However, continued medical services are obtained at specialized clinics across public and private hospitals throughout the Coun- ty. Although Hub Clinics may not offer the specialized services and clinics needed by the medically fragile/vulnerable youth under the MCMS Unit, the Hub Clinics can still play a role as the medical home for youth with multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. The Hub Clinics can also serve as the medical coordinators for the medically fragile/vulnerable Transition Age Youth who are 18 and older and have not transitioned to Regional Center services, such as an 18 year old who is diabetic and is in constant need of insulin shots. To serve as the medi- cal home, Hub Clinics would have to obtain and maintain all medical records for the pa- tient from multiple service providers within the hospital system affiliated with each Hub Clinic. Currently, DCFS staff coordinates services across multiple providers in different hospital systems for these youth, and should continue doing so for youth with medical providers across both County and private hospital systems. However, the specialized medical knowledge of Hub Clinic staff could facilitate the transfer of medical information more easily for medically fragile/vulnerable youth with specialists in the same hospital system. Ideally, youth aging out of DCFS would be transitioned to a program where they still have access to social workers and coordinated medical and mental health services ei- ther through a Regional Center, if developmentally disabled, or Adult Protective Ser- vices. For youth transitioned to Adult Protective Services, the Hub Clinics could com- plement the social services provided by coordinating the youth’s medical services. Mental Health Services for TAYs According to data provided by DMH, 3,904 DCFS youths with open DMH cases were aged 16 or older, representing 16.2 percent of the a total of 24,116 DCFS youths with open DMH cases. This also represents 71.2 percent of the 5,483 youth under the juris- diction of DCFS who were 16 years old or older as of November 30, 2011. These youths could have received DMH services through any number of DMH programs pro- EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 297 vided throughout the County including: 1) services provided through the Multidisciplinary Assessment Team (MAT) Assessment Program,22 2) Full Service Partnership Program (FSP),23 3) Assertive Community Treatment (ACT),24 and 4) Specialized Foster Care In- tensive In-Home Mental Health Services (IIHMHS),25 etc. Only two of the seven Hub Clinics, LAC+USC and Children’s Hospital, have contracts with DMH and have multiple mental health service professionals onsite. The East San Gabriel Valley Satellite Hub Clinic has access to mental health service providers through its affiliation with LAC+USC. Children’s Hospital is the only Hub Clinic that has services directed specifically toward Transition Age Youth. These are provided by the Children Hospital’s Division of Ado- lescent Medicine and located in a clinic separate from the CHLA Hub Clinic for younger children. Services for 12 to 21 year olds include specialized services for adolescents dealing with anger management, depression, substance abuse, homelessness, HIV and transgender issues. These services are provided to all adolescents, not just those re- ferred to the Hub Clinic by DCFS. Furthermore, LAC+USC hopes to obtain additional funding and resources to expand its Children’s Medical Village to include service for adults. This would require staffing the Medical Village with providers who are trained in both pediatrics and adult medicine, similar to the staff at the Children’s Hospital Division of Adolescent Medicine. Further, LAC+USC hopes to include Adult Protective Services staff in its proposed expanded Medical Village to provide easy access to social work services while remaining the med- ical home and coordinator of medical and mental health services for medically frag- ile/vulnerable Transition Age Youth aged 18 and older. Targeted Medical and Mental Health Services for Transition Age Youth As discussed in Section 1 of this report, “The Model Medical Hub Clinic”, model Hub Clinics should serve as the medical home and provide onsite mental health services for youth under the jurisdiction of DCFS. With the implementation of AB 12, youth aged 18 years old and older will continue to be eligible for medical and mental health services at Hub Clinics. At this time, Children’s Hospital is the only Hub Clinic that is able to pro- vide both medical and mental health services that are targeted toward the issues and 22 The Multidisciplinary Assessment Team (MAT) Assessment Program provides comprehensive assessments to evaluate a foster youth’s needs and strengths in various areas including medical, dental, developmental, hear- ing/language, education, mental health, vocational, and family/caregiver issues. The Transition Age Youth Full Service Partnership Program offers intensive services with 24/7 staff availability to help 16 to 25 year olds address emotional, housing, physical health, transportation, and other needs to help them function independently in the community. Assertive Community Treatment is a team-based approach to the provision of treatment, rehabilitation, and support services. A variety of services are offered under the Specialized Foster Care Intensive In-Home Mental Health Services (IIHMHS) program, including 24/7 intensive case management, Trauma Focused Cognitive Behavioral Therapy, Functional Family Therapy, as well as programs to assist caregivers with behavioral and emotional problems in young children. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 298 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT concerns of youth 18 years old and older. Therefore, DCFS should encourage youth 18 years old and older with complex medical and/or mental health needs to go to the Chil- dren’s Hospital services. According to Children’s Hospital staff, should referrals to the adolescent clinic from DCFS increase, the clinic would then consider applying for Federally Qualified Health Center (FQHC) status, which would allow the clinic to receive greater reimbursement for costs than they currently receive through Medi-Cal. However, until the adolescent clinic officially receives such a status, the clinic will need grant funding to absorb the addition- al referrals. Children’s Hospital is not conveniently located for all Transition Age Youth located throughout the County, particularly for the medically fragile/vulnerable youth aged 18 and older. DCFS, DHS, and DMH should work together to identify funding for additional transportation services to and from CHLA. Currently, Children’s Hospital is able to pro- vide transportation passes to youth participating in its Full Service Partnership Program, funded through a DMH contract. Similar funding should be identified or expanded for the additional DCFS referrals of youth to the Children’s Hospital. For youth who are not lo- cated near public transportation, DCFS, DHS, and DMH should explore funding for van services. This type of service is already provided to youth living in the Lancas- ter/Palmdale area for services at the High Desert Hub Clinic. Children’s Hospital currently has the greatest capacity to serve the special needs of Transition Age Youth aged 18 and older. Additionally, resources could be designated or reassigned to LAC+USC to expand its Children’s Medical Village to include medical services for adults and access to Adult Protective Services social workers to meet the medical and mental health needs of Transition Age Youth aged 18 and older. SUMMARY Prior to January 1, 2012, most youth under the jurisdiction of DCFS were emancipated and their DCFS cases were terminated after they turned 18 years old. Though there were exceptions for some 18 year olds to remain under foster care and receive inten- sive case management services, a majority of the youth 18 years old or older received additional DCFS services on a voluntary basis but did not access medical and mental health services at the Hub Clinics. Though most of these youth were eligible for Medi- Cal after they turned 18, which could reimburse the Hub Clinics if used by the youth, their choice of medical provider was left up to them. None of the County-affiliated Hub Clinics made special efforts to encourage these youth to obtain medical care from them. With the passage of extended foster care services through AB 12, as of January 1, 2012, youth under the jurisdiction of DCFS can remain in the child welfare system until the age of 21, as long as they meet certain criteria. Therefore, Transition Age Youth aged 18 to 21 could continue to use Hub Clinics for medical and mental health needs. Their medical care would continue to be reimbursed under the Medi-Cal fee-for-service arrangement, which provides a better cost recovery for the clinics than Medi-Cal man- aged care rates. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 299 A majority of the Hub Clinics currently do not provide medical services to youth under the jurisdiction of DCFS that are 18 years old or older. Youth that are medically frag- ile/vulnerable currently receive medical services from specialized medical providers and clinics throughout the County. Further, only two of the Hub Clinics have Department of Mental Health contracts and multiple mental health providers at their Hub Clinics to pro- vide mental health services to DCFS youth. Only Children’s Hospital LA offers an ado- lescent clinic that provides medical and mental health services targeted toward youth aged 12 to 21. However, LAC+USC has plans to expand its Children’s Medical Village with medical services for adults, particularly Transition Age Youth aged 18 and older, including access to Adult Protective Services social workers. The Hub Clinics could serve as medical homes for medically fragile/vulnerable TAYs by coordinating services among the various specialized medical and mental health provid- ers, as long as they are within the same hospital system. Such coordination would re- quire additional training for the medical providers to be aware of the various issues spe- cific to TAYs. Finally, DCFS and DHS could refer other medically fragile/vulnerable TAYs to Children’s Hospital to benefit from their specialized Adolescent Clinic and initi- ate a plan to establish similar specialty clinics for TAYs at some or all of the County Hub Clinics. The Hub Clinic with the greatest capacity for expansion of services for Transi- tion Age Youth is currently LAC+USC because it is building a Children’s Medical Village with an aim to provide access to subspecialty medical services beginning in the summer of 2012. FINDINGS 5.1. According to national statistics, youth transitioning out of foster care are at risk and have higher rates of homelessness, as well as mental health, physical, and devel- opmental problems. For example, 27 percent of the nation’s homeless population have been in foster care, while youth emancipating out of foster care have a one in six chance of being homeless within one year. 5.2. As of November 30, 2011, there were 1,672 youth under the jurisdiction of DCFS that were 18 or older. Prior to January 1, 2012, most of these youth were emanci- pated and their DCFS cases were terminated after they turned 18 years old. Most of these youth were only able to receive additional DCFS services on a voluntary basis and, though not precluded from doing so, most did not access medical and mental health services at the Hub Clinics which are generally geared toward chil- dren, and have not made efforts to encourage Transition Age Youth emancipating from the child welfare system to use their services. 5.3. With the passage of extended foster care services through AB 12, youth under the jurisdiction of DCFS may now remain in the child welfare system until the age of 21, as long as they meet certain criteria. Based on DCFS data on youth 16 years old and older and under DCFS jurisdiction as of November, 30, 2011, the estimat- ed total number of Transition Age Youth that could remain in DCFS through 2014 ranges from 3,800 to 5,483 youth. EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 300 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 5.4. The number of medically fragile/vulnerable youth with special needs due to a men- tal health diagnosis, developmental delay or a physical or medical condition that requires specific care under the jurisdiction of DCFS was 2,163 as of November 30, 2011, of which 198 were 18 years old or older. Though Hub Clinics may not of- fer the specialized services and clinics needed by the medically fragile/vulnerable youth, the Hub Clinics can still play a role as the medical homes for youth who need to see multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. 5.5. The majority of the Hub Clinics currently do not provide medical services to youth aged 18 years old or older. Further, only two of the Hub Clinics have Department of Health contracts and multiple mental health providers onsite at their Hub Clinics to provide mental health services to DCFS youth. Only Children’s Hospital LA current- ly offers an adolescent clinic that provides medical and mental health services tar- geted toward youth age 12 to 21 years old. However, LAC+USC has plans to ex- pand its Children’s Medical Village, which will provide access to several medical subspecialty services, to include adult medical services for Transition Age Youth aged 18 or older.
Additional Recommendations
1
Not linked to specific findings.
R30-45:
days after acceptance of a referral. However, according to DMH management, though DCFS requires Initial Medical Examinations to be completed at the Hub Clinics within 30 days of initial placement, the actual timing of the Initial Medical Examinations does not always coincide with the 30-45 day requirement for the completion of the MAT Assessment. As discussed in Section 3 of this report, 22.9 percent of the referrals to the Hub Clinics in FY 2010-11 resulted in missed appointments. Because the findings of the MAT Assessment must be presented to the Court, the medical exam is often provided by a community provider. As previously mentioned, a MAT team consisting of various stakeholders and service providers is assembled to evaluate the detained youth’s condition and service needs. According to the Memorandum of Understanding between DCFS and DHS, one of the goals of the Hub Clinics is to “improve coordination and child health care outcomes.” Though their input could be valuable, particularly for youth with Special Health Care Needs,11 except for rare occasions, Hub Clinic staff do not participate in the MAT team meetings. Without the participation of medical Hub Clinic staff and PHNs in MAT team meetings, an opportunity is lost to improve coordination and integration of medical and other care in service plans. PHNs could serve as the critical link between the Hub Clinics and the MAT Assess- ments because of their understanding of medical issues and their responsibility to coun- sel CSWs on medical issues related to their cases. With the approval of additional Title IV-E Waiver funds for hiring PHNs to be co-located at the Hub Clinics, DCFS and DHS should include attending MAT Assessments as one of the prioritized responsibilities of these PHNs. Mental Health Screenings and Ongoing Mental Health Services An additional shared goal of the MAT Assessments conducted by MAT Providers and the Initial Medical Exams conducted at the Hub Clinics is to perform mental health screenings, identify mental health needs, and ensure linkage to additional services. Though there are shared goals in identifying mental health needs, the MAT Providers and the Hub Clinics were provided different mental health screening tools by DMH. In particular, the MAT Providers use a more in-depth screening tool. According to DMH management, the use of different mental health screening tools at the Hub Clinics is dic-
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Findings & Recommendations
3 findings
F1:
The CGJ found that change in the executive-level management has resulted in improved transparency, staff morale, and cooperation with outside agencies.
F2:
Current First 5 LA executive management has been responsive to the audit findings and recommendations.
F3:
First 5 LA has made significant progress in implementing the audit
Additional Recommendations
2
Not linked to specific findings.
R1:
The Chief Executive Officer of First 5 LA should implement the remaining audit recommendations in a timely manner.
R2:
The First 5 LA Commission should monitor the activities of the agency to ensure compliance with revised policies and procedures.
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Findings & Recommendations
3 findings
F1:
Avoid having to make individual written requests for each child’s credit report by developing a procedure for making an electronic batch request containing the identifying information on all age identified children, and transmitting it via a secure channel to the various CRBs.
F2:
Remove any records found from the children’s credit reports without incurring significant workload or cost.
F3:
Protect the children from any further negative impact of fraud after remediation of the records found had been completed. The Pilot Project submitted 2,110 records of 16 year-olds and found a total of 104 records (5% of the pilot project sample) had been corrupted or compromised. The Pilot Project focused on removing the credit records of foster children rather than leading to the prosecution of identity thieves. According to the Pilot Project findings of the 16 year olds studied, the average age of a foster child when the fraudulent account was opened was 14 years old. Of the 104 records that were found to be corrupted, the largest fraudulent loans were: one home loan that was over $200,000, four major loans, and three auto loans. The Pilot Project removed the fraudulent records; however, it did not “suppress” the files of the foster children in the CRB records to prevent further identity theft. Suppression means that the credit record is not available to anyone except the foster child with adequate proof of identification, and a PIN is not required to be given to the various agencies or foster parents. The corrupted records of the identified 16 year olds found in the Pilot Project should have been immediately suppressed to prevent any further degradation of the foster child’s credit. The Identity Theft Project (ITP) was also created to accommodate the juveniles in the Foster Care System who are monitored by the Probation Department; however, this group of juveniles was not included in the Pilot Project. The CGJ noted that Section §10618.6 added to the Welfare and Institutions Code did not address the need to protect foster children on a continuing basis from criminal corruption of their credit reports. The information contained in the foster child’s identification card is necessary for the persons or institutions that care for the foster child. In order to claim appropriate 4 www.privacy.ca.gov/consumers/foster_youth.pdf, and see Exhibit 2. IDENTITY THEFT 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 311 Federal and State tax deductions and other financial inducements to caretakers of foster children, the SSN has to be provided to those agencies. The CGJ determined that prevention of misuse of the information contained in foster children CRB files was preferable to the correction of these corrupted files by DCA. The CGJ’s goal was to reduce the effort of DCA to a minimum in the future.
Additional Recommendations
6
Not linked to specific findings.
R1:
Scalability: Going Statewide The procedures used in the pilot project for ordering credit reports and transmitting the sensitive data electronically among DCFS, the CRAs and the remediation agencies proved both efficient and secure. Based on the pilot project, the work of a foster care agency in creating and transmitting a report of foster children’s identifying information and then transmitting it to the three CRAs on a quarterly basis would amount to less than 100 hours a year plus one-time work at start-up of less than 50 hours. This workload would be the same regardless of the number of records in the report. For each of California’s 58 counties to do the same thing would mean 58 times the workload statewide. The CRAs have said that they could not use the pilot project data transmission procedures for all the counties individually. We also have serious concerns about the security risks of involving so many entities in transmitting such sensitive data. The “manual” alternative of the county agencies sending individual written requests to the credit reporting agencies, providing the necessary documentation for each child, would be far more labor- intensive than making a bulk request electronically. The counties would then have to send the paper credit reports received to the remediation agencies, which would add to the workload and the security risk. The last thing we want to do is to expose foster children IDENTITY THEFT – EXHIBIT 2 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 331 C a l i f o r n i a O f f i c e o f P r i v a c y P r o t e c t i o n | 15 to identity theft through the process intended to protect them from its consequences. See
R2:
IV. Recommendations 1. The California law on foster child identity theft focuses on clearing the children’s credit records of fraudulent or erroneous information that could harm them in the future, not on ferreting out identity thieves. Nevertheless, the data received from the credit reporting agencies for the pilot project should be helpful in identifying possible indications of the crime. We recommend that the Los Angeles County Department of Children and Family Services, which received the data at the completion of the pilot project, provide the data to law enforcement to review for indications of identity theft. We also recommend that the Department review the data for any implications for their own internal procedures and make any changes to those procedures indicated by their findings. 2. In expanding the foster child identity theft protection program statewide, California should strive to centralize requests for credit reports rather than make them on county-by-county basis. As discussed above, while the data transmission procedures used in the pilot project proved both efficient and secure, the credit reporting agencies have said they would not use the procedures for California’s 58 counties individually. An alternative would be to centralize the transmission of requests for credit reports at the state level, through the Department of Social Services, which has the data on foster children statewide. Or perhaps, since half the foster children in the state are in Los Angeles County, the County Department of Children and Family Services could continue to perform that task for their county, with the other 57 counties’ data being submitted at the state level. The remediation activities could continue to be performed by the Los Angeles County Department of Consumer Affairs for that county and by the California Office of Privacy Protection for other counties, unless there are county agencies able to take on the remediation work. While the California law would allow for remediation to be performed by non-governmental organizations, we believe that a government agency is more likely to be successful in “certifying” to creditors and collectors the status of the children as minors in foster care. 3. We recommend that the credit reporting agencies explore the possibility of protecting children by offering parents and legal guardians, including foster care agencies, the ability to “suppress” the identities of minor children in the credit IDENTITY THEFT - EXHIBIT 2 332 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT C a l i f o r n i a O f f i c e o f P r i v a c y P r o t e c t i o n | 16 reporting systems. The agencies might also explore developing a secure, automated procedure for requesting the credit records of minors. 4. We recommend that the credit reporting agencies consider how to address the potential for harm to children (and adults) of the agencies’ maintenance and use of records tied to individuals by Social Security numbers only, such as the SSN- only records found in the pilot project. When two or more profiles are reporting information using the same Social Security number, the accuracy of the resulting records would seem to be in question and further disclosure of such inaccurate information can create problems for consumers. 5. We recommend that the credit reporting agencies consider how to limit the potential harm to minors of “authorized user” accounts reported by some data furnishers. The practice of some creditors (data furnishers) of reporting an account in the name of an authorized user may create problems for a minor child. An authorized user is not financially responsible for the obligation and we understand that such an account is not factored into calculations of the authorized user’s credit score, although some of the creditors we spoke with believed that having a credit record as an authorized user helps the child establish a credit rating. The reporting of such accounts can inappropriately create a credit record for a minor and can result in debt collectors pursuing the child. IDENTITY THEFT – EXHIBIT 2 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 333 C a l i f o r n i a O f f i c e o f P r i v a c y P r o t e c t i o n | 17 Acknowledgements The project that is the subject of this report was truly a team effort. Many participants were involved for over a year, from the first formulation of the plan to the completion of the report. The credit reporting agencies played an important role and I am particularly grateful for the assistance of Laura Mundy, Paul Hernandez and Cathy Jones of Experian, the agency that went first in pulling the credit records of the test population. Their willingness to answer our many questions and help us work through the project’s complicated issues is very much appreciated. I also want to thank Diane Terry and her colleagues at TransUnion and Gary Poch and his at Equifax for their helpfulness. At the Los Angeles County Department of Consumer Affairs, our partners in tackling the task of clearing up the records were Rigoberto Reyes, Dawnnesha Smith, Kirk Shelton and Alejandra Zepeda. Their expertise was invaluable and their camaraderie kept us going on what turned out to be a longer project path than we had originally envisioned. I also want to acknowledge the contributions of the dedicated people who work full time on behalf of foster children: Harvey Kawasaki, Lisa-Marie Kaye, Jason Ly and Rhelda Shabazz at the Los Angeles County Department of Children and Family Services, and Theresa Thurmond at the California Department of Social Services. And finally this task would not have been possible without the devoted project team at the California Office of Privacy Protection. Debra Castanon took on a lead role and resolved the most difficult issues throughout the project. Nicole Lee worked on the project for over a year, arranging meetings, keeping records, and advocating the interests of the children with hundreds of creditors and collectors, with the assistance of Christina Savage. Christina Halle also did important work in ensuring the quality of the data and uncovering its significance. Everyone who worked on this project demonstrated not only skill and dedication, but also great empathy for California’s foster children.
R3:
To Catch the Thieves At the end of the pilot, the data received from the CRAs and copies of the clearance letters from creditors and collectors were provided to DCFS. We have suggested to DCFS that they add the clearance letters to the files of important documents that foster children receive upon emancipation, for use in the event that they experience problems with their credit records in the future. We have also encouraged DCFS to work with DCA in bringing the data to the attention of local law enforcement for investigation. See
R4:
The Director of DCA should assume the lead role in correcting the corrupted CRB records of foster children. Corrupted CRB records of foster children should be corrected by a governmental agency such as DCA to prevent the foster child from being exposed to the expense and complexity of dealing with the various commercial agencies that deal with identity theft (see Exhibit 1).
R5:
The Director of DCA should expand its existing telephone voicemail system to add a menu number for the aged out foster children who are encountering identity theft problems, and other problems unique to aging out of the foster care system.
R6:
The Director of DCA should solicit, train, and encourage the use of senior citizen volunteers to aid the aging out foster youths in dealing with preventing future identity theft and fraud. Senior citizen DCA volunteers could be used to assist the foster youths by educating and acquainting them with resources such as the proper use of credit and debit cards. IDENTITY THEFT 312 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
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Findings & Recommendations
3 findings
F1:
Avoid having to make individual written requests for each child’s credit report by developing a procedure for making an electronic batch request containing the identifying information on all age identified children, and transmitting it via a secure channel to the various CRBs.
F2:
Remove any records found from the children’s credit reports without incurring significant workload or cost.
F3:
Protect the children from any further negative impact of fraud after remediation of the records found had been completed. The Pilot Project submitted 2,110 records of 16 year-olds and found a total of 104 records (5% of the pilot project sample) had been corrupted or compromised. The Pilot Project focused on removing the credit records of foster children rather than leading to the prosecution of identity thieves. According to the Pilot Project findings of the 16 year olds studied, the average age of a foster child when the fraudulent account was opened was 14 years old. Of the 104 records that were found to be corrupted, the largest fraudulent loans were: one home loan that was over $200,000, four major loans, and three auto loans. The Pilot Project removed the fraudulent records; however, it did not “suppress” the files of the foster children in the CRB records to prevent further identity theft. Suppression means that the credit record is not available to anyone except the foster child with adequate proof of identification, and a PIN is not required to be given to the various agencies or foster parents. The corrupted records of the identified 16 year olds found in the Pilot Project should have been immediately suppressed to prevent any further degradation of the foster child’s credit. The Identity Theft Project (ITP) was also created to accommodate the juveniles in the Foster Care System who are monitored by the Probation Department; however, this group of juveniles was not included in the Pilot Project. The CGJ noted that Section §10618.6 added to the Welfare and Institutions Code did not address the need to protect foster children on a continuing basis from criminal corruption of their credit reports. The information contained in the foster child’s identification card is necessary for the persons or institutions that care for the foster child. In order to claim appropriate 4 www.privacy.ca.gov/consumers/foster_youth.pdf, and see Exhibit 2. IDENTITY THEFT 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 311 Federal and State tax deductions and other financial inducements to caretakers of foster children, the SSN has to be provided to those agencies. The CGJ determined that prevention of misuse of the information contained in foster children CRB files was preferable to the correction of these corrupted files by DCA. The CGJ’s goal was to reduce the effort of DCA to a minimum in the future.
Additional Recommendations
6
Not linked to specific findings.
R1:
Scalability: Going Statewide The procedures used in the pilot project for ordering credit reports and transmitting the sensitive data electronically among DCFS, the CRAs and the remediation agencies proved both efficient and secure. Based on the pilot project, the work of a foster care agency in creating and transmitting a report of foster children’s identifying information and then transmitting it to the three CRAs on a quarterly basis would amount to less than 100 hours a year plus one-time work at start-up of less than 50 hours. This workload would be the same regardless of the number of records in the report. For each of California’s 58 counties to do the same thing would mean 58 times the workload statewide. The CRAs have said that they could not use the pilot project data transmission procedures for all the counties individually. We also have serious concerns about the security risks of involving so many entities in transmitting such sensitive data. The “manual” alternative of the county agencies sending individual written requests to the credit reporting agencies, providing the necessary documentation for each child, would be far more labor- intensive than making a bulk request electronically. The counties would then have to send the paper credit reports received to the remediation agencies, which would add to the workload and the security risk. The last thing we want to do is to expose foster children IDENTITY THEFT – EXHIBIT 2 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 331 C a l i f o r n i a O f f i c e o f P r i v a c y P r o t e c t i o n | 15 to identity theft through the process intended to protect them from its consequences. See
R2:
IV. Recommendations 1. The California law on foster child identity theft focuses on clearing the children’s credit records of fraudulent or erroneous information that could harm them in the future, not on ferreting out identity thieves. Nevertheless, the data received from the credit reporting agencies for the pilot project should be helpful in identifying possible indications of the crime. We recommend that the Los Angeles County Department of Children and Family Services, which received the data at the completion of the pilot project, provide the data to law enforcement to review for indications of identity theft. We also recommend that the Department review the data for any implications for their own internal procedures and make any changes to those procedures indicated by their findings. 2. In expanding the foster child identity theft protection program statewide, California should strive to centralize requests for credit reports rather than make them on county-by-county basis. As discussed above, while the data transmission procedures used in the pilot project proved both efficient and secure, the credit reporting agencies have said they would not use the procedures for California’s 58 counties individually. An alternative would be to centralize the transmission of requests for credit reports at the state level, through the Department of Social Services, which has the data on foster children statewide. Or perhaps, since half the foster children in the state are in Los Angeles County, the County Department of Children and Family Services could continue to perform that task for their county, with the other 57 counties’ data being submitted at the state level. The remediation activities could continue to be performed by the Los Angeles County Department of Consumer Affairs for that county and by the California Office of Privacy Protection for other counties, unless there are county agencies able to take on the remediation work. While the California law would allow for remediation to be performed by non-governmental organizations, we believe that a government agency is more likely to be successful in “certifying” to creditors and collectors the status of the children as minors in foster care. 3. We recommend that the credit reporting agencies explore the possibility of protecting children by offering parents and legal guardians, including foster care agencies, the ability to “suppress” the identities of minor children in the credit IDENTITY THEFT - EXHIBIT 2 332 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT C a l i f o r n i a O f f i c e o f P r i v a c y P r o t e c t i o n | 16 reporting systems. The agencies might also explore developing a secure, automated procedure for requesting the credit records of minors. 4. We recommend that the credit reporting agencies consider how to address the potential for harm to children (and adults) of the agencies’ maintenance and use of records tied to individuals by Social Security numbers only, such as the SSN- only records found in the pilot project. When two or more profiles are reporting information using the same Social Security number, the accuracy of the resulting records would seem to be in question and further disclosure of such inaccurate information can create problems for consumers. 5. We recommend that the credit reporting agencies consider how to limit the potential harm to minors of “authorized user” accounts reported by some data furnishers. The practice of some creditors (data furnishers) of reporting an account in the name of an authorized user may create problems for a minor child. An authorized user is not financially responsible for the obligation and we understand that such an account is not factored into calculations of the authorized user’s credit score, although some of the creditors we spoke with believed that having a credit record as an authorized user helps the child establish a credit rating. The reporting of such accounts can inappropriately create a credit record for a minor and can result in debt collectors pursuing the child. IDENTITY THEFT – EXHIBIT 2 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 333 C a l i f o r n i a O f f i c e o f P r i v a c y P r o t e c t i o n | 17 Acknowledgements The project that is the subject of this report was truly a team effort. Many participants were involved for over a year, from the first formulation of the plan to the completion of the report. The credit reporting agencies played an important role and I am particularly grateful for the assistance of Laura Mundy, Paul Hernandez and Cathy Jones of Experian, the agency that went first in pulling the credit records of the test population. Their willingness to answer our many questions and help us work through the project’s complicated issues is very much appreciated. I also want to thank Diane Terry and her colleagues at TransUnion and Gary Poch and his at Equifax for their helpfulness. At the Los Angeles County Department of Consumer Affairs, our partners in tackling the task of clearing up the records were Rigoberto Reyes, Dawnnesha Smith, Kirk Shelton and Alejandra Zepeda. Their expertise was invaluable and their camaraderie kept us going on what turned out to be a longer project path than we had originally envisioned. I also want to acknowledge the contributions of the dedicated people who work full time on behalf of foster children: Harvey Kawasaki, Lisa-Marie Kaye, Jason Ly and Rhelda Shabazz at the Los Angeles County Department of Children and Family Services, and Theresa Thurmond at the California Department of Social Services. And finally this task would not have been possible without the devoted project team at the California Office of Privacy Protection. Debra Castanon took on a lead role and resolved the most difficult issues throughout the project. Nicole Lee worked on the project for over a year, arranging meetings, keeping records, and advocating the interests of the children with hundreds of creditors and collectors, with the assistance of Christina Savage. Christina Halle also did important work in ensuring the quality of the data and uncovering its significance. Everyone who worked on this project demonstrated not only skill and dedication, but also great empathy for California’s foster children.
R3:
To Catch the Thieves At the end of the pilot, the data received from the CRAs and copies of the clearance letters from creditors and collectors were provided to DCFS. We have suggested to DCFS that they add the clearance letters to the files of important documents that foster children receive upon emancipation, for use in the event that they experience problems with their credit records in the future. We have also encouraged DCFS to work with DCA in bringing the data to the attention of local law enforcement for investigation. See
R4:
The Director of DCA should assume the lead role in correcting the corrupted CRB records of foster children. Corrupted CRB records of foster children should be corrected by a governmental agency such as DCA to prevent the foster child from being exposed to the expense and complexity of dealing with the various commercial agencies that deal with identity theft (see Exhibit 1).
R5:
The Director of DCA should expand its existing telephone voicemail system to add a menu number for the aged out foster children who are encountering identity theft problems, and other problems unique to aging out of the foster care system.
R6:
The Director of DCA should solicit, train, and encourage the use of senior citizen volunteers to aid the aging out foster youths in dealing with preventing future identity theft and fraud. Senior citizen DCA volunteers could be used to assist the foster youths by educating and acquainting them with resources such as the proper use of credit and debit cards. IDENTITY THEFT 312 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
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Findings & Recommendations
8 findings
F1:
The CGJ found that the per-inmate cost of medications at LASD was higher than the surveyed counties in all but one county.
F2:
The procurement of medications is through a contract provider (drug wholesaler) via the Electronic Countywide Accounting Purchasing System (ECAPS). ECAPS does not provide the capability for use of a perpetual inventory system. A perpetual in- ventory is an ongoing count of medications, on hand, at any particular point in time. Control drugs are inventoried on a perpetual system called the C-2 PYXIS System.
F3:
The total LASD pharmacy services staff was 119 people at the time of inspection. This includes:
• 1 chief pharmacist
• 2 pharmacy supervisors
• 1 procurement pharmacist
• 51 general pharmacists
• 60 pharmacy technicians
• 2 pharmacy helpers
• 2 typist clerks
F4:
The configurations of personnel at the three licensed pharmacies were:
• Twin Towers: 1 pharmacy supervisor, 2 pharmacists, 2 pharmacy technicians, 1 pharmacy helper per shift
• Men’s Central Jail: 1 pharmacy supervisor, 2 pharmacists, 2 pharmacy techni- cians, 1 pharmacy helper per shift
• CRDF: 1 pharmacy supervisor, 2 pharmacists, 2 pharmacy technicians, 1 phar- macy helper per shift
F5:
LASD pharmacies use the AutoMed System manufactured by Amersource-Bergen Company. 57% percent of all prescriptions dispensed by the LASD pharmacies are via automation.
F6:
The transmittal of medication orders was performed electronically.
F7:
Verification of medications dispensed from the C-2PYXIS system was done by pharmacists and recorded manually.
F8:
The pharmacies at MCJ and CRDF have limited space for the storage and dispens- ing of all items necessary to provide medications for inmates. INMATE MEDICATIONS 160 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
6
Not linked to specific findings.
R1:
The Los Angeles County Sheriff’s Department should provide a system similar to the C-2 PYXIS system for maintaining a perpetual inventory system for all medica- tions supplied to the Los Angeles County Sheriff’s Department Pharmacies.
R2:
The Los Angeles County Sheriff’s Department pharmacy personnel should re- duce the daily costs of medications prescribed by doctors for inmate needs through the increased use of generic drugs as they become available.
R3:
The Los Angeles County Sheriff’s Department pharmacy personnel should in- crease the use of automated dispensing of medications via the AutoMed System to a staff-recommended level of 75% of all medications to provide better control and accuracy of dispensed medications.
R4:
The Los Angeles County Sheriff’s Department pharmacy should use an automat- ed system for monitoring and recording all medications dispensed via the AutoMed System.
R5:
The Los Angeles County Sheriff’s Department should provide additional space to maintain adequate working areas for the pharmacy personnel and storage of all medications at Men’s Central Jail and Century Regional Detention Facility.
R6:
The Los Angeles County Sheriff’s Department should continue its plans to open a State-licensed pharmacy at Pitchess Detention Center within the next fiscal year.
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Findings & Recommendations
8 findings
F1:
The CGJ found that the per-inmate cost of medications at LASD was higher than the surveyed counties in all but one county.
F2:
The procurement of medications is through a contract provider (drug wholesaler) via the Electronic Countywide Accounting Purchasing System (ECAPS). ECAPS does not provide the capability for use of a perpetual inventory system. A perpetual in- ventory is an ongoing count of medications, on hand, at any particular point in time. Control drugs are inventoried on a perpetual system called the C-2 PYXIS System.
F3:
The total LASD pharmacy services staff was 119 people at the time of inspection. This includes:
• 1 chief pharmacist
• 2 pharmacy supervisors
• 1 procurement pharmacist
• 51 general pharmacists
• 60 pharmacy technicians
• 2 pharmacy helpers
• 2 typist clerks
F4:
The configurations of personnel at the three licensed pharmacies were:
• Twin Towers: 1 pharmacy supervisor, 2 pharmacists, 2 pharmacy technicians, 1 pharmacy helper per shift
• Men’s Central Jail: 1 pharmacy supervisor, 2 pharmacists, 2 pharmacy techni- cians, 1 pharmacy helper per shift
• CRDF: 1 pharmacy supervisor, 2 pharmacists, 2 pharmacy technicians, 1 phar- macy helper per shift
F5:
LASD pharmacies use the AutoMed System manufactured by Amersource-Bergen Company. 57% percent of all prescriptions dispensed by the LASD pharmacies are via automation.
F6:
The transmittal of medication orders was performed electronically.
F7:
Verification of medications dispensed from the C-2PYXIS system was done by pharmacists and recorded manually.
F8:
The pharmacies at MCJ and CRDF have limited space for the storage and dispens- ing of all items necessary to provide medications for inmates. INMATE MEDICATIONS 160 2011-2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
6
Not linked to specific findings.
R1:
The Los Angeles County Sheriff’s Department should provide a system similar to the C-2 PYXIS system for maintaining a perpetual inventory system for all medica- tions supplied to the Los Angeles County Sheriff’s Department Pharmacies.
R2:
The Los Angeles County Sheriff’s Department pharmacy personnel should re- duce the daily costs of medications prescribed by doctors for inmate needs through the increased use of generic drugs as they become available.
R3:
The Los Angeles County Sheriff’s Department pharmacy personnel should in- crease the use of automated dispensing of medications via the AutoMed System to a staff-recommended level of 75% of all medications to provide better control and accuracy of dispensed medications.
R4:
The Los Angeles County Sheriff’s Department pharmacy should use an automat- ed system for monitoring and recording all medications dispensed via the AutoMed System.
R5:
The Los Angeles County Sheriff’s Department should provide additional space to maintain adequate working areas for the pharmacy personnel and storage of all medications at Men’s Central Jail and Century Regional Detention Facility.
R6:
The Los Angeles County Sheriff’s Department should continue its plans to open a State-licensed pharmacy at Pitchess Detention Center within the next fiscal year.
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Findings & Recommendations
11 findings
F1:
The Coroner has enlarged its morgue space and has built an adjacent building with a 500 slab capacity for the storage of bodies.
F2:
The Coroner transfers unclaimed remains to Los Angeles County+USC Hospital for cremation services and no longer performs these services.
F3:
The Emergency Operations Plan provided to the CGJ was a comprehensive plan adopted on March 22, 2011. The EOP appeared to be a plan written and adopted by a state wide organization. Many of the positions of responsibility are not specific to the personnel currently employed by the Coroner. Even though job descriptions are specified, actual responsibilities are difficult to determine.
F4:
The EOP does not provide training or continued education programs with key per- sonnel. Continued formal training is a key component for success in implementation of the EOP.
F5:
The position of Director is scheduled to become vacant as of March 2012 due to the retirement of the current Director. The Chief Medical Examiner is also scheduled to retire at the end of 2012. However, the Succession Plan does not provide the search progress, the qualifications, or the possible candidates for the filling of vacant positions at the Coroner nor does it provide a direct succession plan for the key posi- tions such as the Chief Medical Examiner or Director.
F6:
The Coroner currently uses an antiquated, non-web based, non-secure file man- agement system that can no longer be upgraded. Intake of bodies and evidence is currently tracked manually, not electronically. This leaves evidence open to error in criminal cases and identification matters. These handwritten documents are filed in individual folders in cabinets. Currently, in the event of a fire or flood, all records could be lost or destroyed.
F7:
The Coroner Forensic Science Laboratories have been accredited since 1993. New requirements for accreditation are being adopted by ISO and the need for a special- ist to ensure the accreditation process is met is critical.
F8:
Budget restrictions have eliminated the replacement of vehicles in the last three years and several vehicles have exceeded the 100,000 mileage marker.
F9:
The Coroner has no power back-up generators to use in the event of power outages.
F10:
The Antelope Valley Regional Office of the Coroner is over 25 years old. It does not meet the need for Coroner services in the high desert.
F11:
The Coroner’s security system should be updated in light of the extreme sensitivity of the Coroner’s forensic operations. CORONER 150 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
9
Not linked to specific findings.
R1:
The Los Angeles County Office of the Coroner should assign specific employees to act as the Department Emergency Coordinator, Public Information Officer, Opera- tions Section Chief, Logistics Section Chief, Finance/Administration Section Chief, and Coroner Representative to the County Emergency Operations Center. These positions should be filled by other specific, capable, and qualified employees in the event that those assigned employees are no longer employed by the Coroner or un- able to perform the assigned duties.
R2:
The Los Angeles County Office of the Coroner should provide ongoing training for all employees on a regular basis.
R3:
The Los Angeles County Board of Supervisors should begin an immediate search for a replacement of the Chief Medical Examiner prior to the retirement of the current Chief Medical Examiner in 2012.
R4:
The Los Angeles County Office of the Coroner should seek the necessary fund- ing for the adoption of the Electronic Case File System (ECFS) necessary for the Coroner to track and manage coroner case documents, including evidence, photo- graphs, and other related objects or materials.
R5:
The Los Angeles County Office of the Coroner should create a Senior Criminalist position dedicated to quality assurance to ensure a successful ISO Laboratory Ac- creditation.
R6:
The Los Angeles County Office of the Coroner should purchase four additional vehicles necessary for the Coroner to provide the services necessary for the County.
R7:
The Los Angeles County Office of the Coroner should seek and purchase/pursue three generators for the Coroner for use in case of power outages during emergency situations.
R8:
The Los Angeles County Office of the Coroner should upgrade or replace the An- telope Valley Regional Office.
R9:
The Los Angeles County Office of the Coroner should establish a keyless card entry system for security of the building used by the Coroner.
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Findings & Recommendations
11 findings
F1:
The Coroner has enlarged its morgue space and has built an adjacent building with a 500 slab capacity for the storage of bodies.
F2:
The Coroner transfers unclaimed remains to Los Angeles County+USC Hospital for cremation services and no longer performs these services.
F3:
The Emergency Operations Plan provided to the CGJ was a comprehensive plan adopted on March 22, 2011. The EOP appeared to be a plan written and adopted by a state wide organization. Many of the positions of responsibility are not specific to the personnel currently employed by the Coroner. Even though job descriptions are specified, actual responsibilities are difficult to determine.
F4:
The EOP does not provide training or continued education programs with key per- sonnel. Continued formal training is a key component for success in implementation of the EOP.
F5:
The position of Director is scheduled to become vacant as of March 2012 due to the retirement of the current Director. The Chief Medical Examiner is also scheduled to retire at the end of 2012. However, the Succession Plan does not provide the search progress, the qualifications, or the possible candidates for the filling of vacant positions at the Coroner nor does it provide a direct succession plan for the key posi- tions such as the Chief Medical Examiner or Director.
F6:
The Coroner currently uses an antiquated, non-web based, non-secure file man- agement system that can no longer be upgraded. Intake of bodies and evidence is currently tracked manually, not electronically. This leaves evidence open to error in criminal cases and identification matters. These handwritten documents are filed in individual folders in cabinets. Currently, in the event of a fire or flood, all records could be lost or destroyed.
F7:
The Coroner Forensic Science Laboratories have been accredited since 1993. New requirements for accreditation are being adopted by ISO and the need for a special- ist to ensure the accreditation process is met is critical.
F8:
Budget restrictions have eliminated the replacement of vehicles in the last three years and several vehicles have exceeded the 100,000 mileage marker.
F9:
The Coroner has no power back-up generators to use in the event of power outages.
F10:
The Antelope Valley Regional Office of the Coroner is over 25 years old. It does not meet the need for Coroner services in the high desert.
F11:
The Coroner’s security system should be updated in light of the extreme sensitivity of the Coroner’s forensic operations. CORONER 150 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
9
Not linked to specific findings.
R1:
The Los Angeles County Office of the Coroner should assign specific employees to act as the Department Emergency Coordinator, Public Information Officer, Opera- tions Section Chief, Logistics Section Chief, Finance/Administration Section Chief, and Coroner Representative to the County Emergency Operations Center. These positions should be filled by other specific, capable, and qualified employees in the event that those assigned employees are no longer employed by the Coroner or un- able to perform the assigned duties.
R2:
The Los Angeles County Office of the Coroner should provide ongoing training for all employees on a regular basis.
R3:
The Los Angeles County Board of Supervisors should begin an immediate search for a replacement of the Chief Medical Examiner prior to the retirement of the current Chief Medical Examiner in 2012.
R4:
The Los Angeles County Office of the Coroner should seek the necessary fund- ing for the adoption of the Electronic Case File System (ECFS) necessary for the Coroner to track and manage coroner case documents, including evidence, photo- graphs, and other related objects or materials.
R5:
The Los Angeles County Office of the Coroner should create a Senior Criminalist position dedicated to quality assurance to ensure a successful ISO Laboratory Ac- creditation.
R6:
The Los Angeles County Office of the Coroner should purchase four additional vehicles necessary for the Coroner to provide the services necessary for the County.
R7:
The Los Angeles County Office of the Coroner should seek and purchase/pursue three generators for the Coroner for use in case of power outages during emergency situations.
R8:
The Los Angeles County Office of the Coroner should upgrade or replace the An- telope Valley Regional Office.
R9:
The Los Angeles County Office of the Coroner should establish a keyless card entry system for security of the building used by the Coroner.
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Findings & Recommendations
2 findings
F1:
Veteran DPOs have been assigned new N3 probationers to supervise. The case- load for the current DPOs has increased dramatically for each DPO to monitor and supervise adequately. Prior to the enactment of AB 109/117, each DPO had ap- proximately 2,500 probationers to supervise. Since AB 109/117, probation has shifted probation cases for supervision away from these veteran DPOs in order to monitor the new N3 probationers.
F2:
The number of released N3s to LAC from October 2011 through mid- March 2012 is well above the projected numbers by LASD. LASD anticipated between 7,000 to 8,000 N3s to be released to LAC during the first year beginning October 2011. Be- tween October 1, 2011 and February 13, 2012, 4,749 N3s have been sent to LAC. This number is approximately 950 N3s per month or a projected 11,400 over a twelve month period.
Additional Recommendations
2
Not linked to specific findings.
R1:
The Los Angeles County Board of Supervisors should lift the hiring freeze for the Probation Department and authorize the hiring of additional Deputy Probation Offic- ers to work with probationers released to the County in order to limit the caseloads on each DPO.
R2:
The Los Angeles County Probation Department should assign veteran and expe- rienced Deputy Probation Officers at each Probation HUB, whose sole responsibility is to monitor and supervise the incoming N3 probationers from the State prisons. Recommendation Responding Agency 1 The Los Angeles County Board of Supervisors 2 The Los Angeles County Probation Department PROBATION 348 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT ACRONYMS AB 109/117 California State Assembly Bill 109/117 BOS Los Angeles County Board of Supervisors CCP Community Corrections Partnership CDCR California Department of Corrections and Rehabilitations CGJ 2011-2012 Los Angeles County Civil Grand Jury DPO Deputy Probation Officer LAC Los Angeles County LAPD Los Angeles Police Department LASD Los Angeles County Sheriff’s Department N3s Non-violent, Non-sexual, Non-serious offenders PRCS Post Release Community Supervision Probation Los Angeles County Probation Department PSRA Public Safety Realignment Act
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Findings & Recommendations
2 findings
F1:
Veteran DPOs have been assigned new N3 probationers to supervise. The case- load for the current DPOs has increased dramatically for each DPO to monitor and supervise adequately. Prior to the enactment of AB 109/117, each DPO had ap- proximately 2,500 probationers to supervise. Since AB 109/117, probation has shifted probation cases for supervision away from these veteran DPOs in order to monitor the new N3 probationers.
F2:
The number of released N3s to LAC from October 2011 through mid- March 2012 is well above the projected numbers by LASD. LASD anticipated between 7,000 to 8,000 N3s to be released to LAC during the first year beginning October 2011. Be- tween October 1, 2011 and February 13, 2012, 4,749 N3s have been sent to LAC. This number is approximately 950 N3s per month or a projected 11,400 over a twelve month period.
Additional Recommendations
2
Not linked to specific findings.
R1:
The Los Angeles County Board of Supervisors should lift the hiring freeze for the Probation Department and authorize the hiring of additional Deputy Probation Offic- ers to work with probationers released to the County in order to limit the caseloads on each DPO.
R2:
The Los Angeles County Probation Department should assign veteran and expe- rienced Deputy Probation Officers at each Probation HUB, whose sole responsibility is to monitor and supervise the incoming N3 probationers from the State prisons. Recommendation Responding Agency 1 The Los Angeles County Board of Supervisors 2 The Los Angeles County Probation Department PROBATION 348 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT ACRONYMS AB 109/117 California State Assembly Bill 109/117 BOS Los Angeles County Board of Supervisors CCP Community Corrections Partnership CDCR California Department of Corrections and Rehabilitations CGJ 2011-2012 Los Angeles County Civil Grand Jury DPO Deputy Probation Officer LAC Los Angeles County LAPD Los Angeles Police Department LASD Los Angeles County Sheriff’s Department N3s Non-violent, Non-sexual, Non-serious offenders PRCS Post Release Community Supervision Probation Los Angeles County Probation Department PSRA Public Safety Realignment Act
Additional Recommendations
8
Not linked to specific findings.
R1:
The Department of Children and Family Services should continue to implement those recommendations that are currently partially implemented or still in progress at the end of the Fiscal Year 2012-2013.
R2:
The Department of Children and Family Services should endeavor to include as part of its yearly budget those recommendations that were not implemented due to budgetary constraints for the Fiscal Year 2012-2013.
R3:
DCFS, Probation, DMH, and DPSS should develop and implement innovative programs to target high-risk families and high-risk children for proactive early inter- vention. Partially Implemented - July, 2013 The Community-Based Support Division has several prevention-based projects recently ap- proved to receive an increase to their funding through the Title IV-E Waiver. On December 13, 2011 the Board of Supervisors agreed with the proposal to utilize Title IV-E Waiver funds to increase the Prevention Initiative Demonstration Project (PlDP) by an additional $1.25 million for fiscal year 2011-2012, and to fund an additional year (FY2012- 2013) at a total program budget of $2.5 million. In conjunction with DCFS Regional Offices, most DCSF REVIEW – EXHIBIT 1-C 362 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 2007–2008 Item and Recommendation Status and Response PlDP agencies have initiated Visitation Centers at faith-based community centers to provide safe and family-centered, locations when monitors are required for visitation. The Year-Two PlDP Evaluation and Executive Summary reports have been completed and the results and recommendations were presented to the Board Deputies as well as the Children's Commission. This evaluation provided evidence based results demonstrating generally positive outcomes for building family strengths; safer communities; decreased subsequent referrals to the child abuse hot line and increased family sta- bility. DCFS has requested and extension of the PlDP program through June 30, 2013. Further- more, several of the more promising strategies are being incorporated into the Promoting Safe and Stable Families/CAPIT program re-design, which is projected to begin July 1, 2013. In addition to prevention programs, addressing the needs of high-risk communities requires con- sideration of caseload size and complexity, re- cruitment and retention for social workers serving these communities. Difficulty in working with cli- ents and the scarcity of resources to meet the needs of the community must be acknowledged. In high risk communities, there is increased pov- erty, high rates of unemployment, high crime rates, and significant disparities in health related issues, which all impact family functioning and add to the complexity of case issues. 3d. More intensive programs on drugs and access to drug rehabilitation pro- grams should be provided to parents for themselves and their children. Partially Implemented - January, 2013 DCFS and the Department of Public Health (DPH) Substance Abuse Prevention and Control (SAPC) are working to strengthen collaborative efforts through Project SAFE (Screening and As- sessment for Family Engagement). Specifically, the Project SAFE collaboration seeks to strengthen the screening and assessment pro- cess for better identification of the needs of cli- ents with substance use disorders and provide timely access to treatment. The intent of this ini- tiative is to develop a comprehensive screening and assessment protocol emphasizing clinical assessments and therapeutic interventions by DCSF REVIEW – EXHIBIT 1-C 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 363 2007–2008 Item and Recommendation Status and Response substance abuse experts. 4a. A suitable overlap of mentors should be built into the program to ease a child's transition to the new mentor. Not Implemented - On-going There are currently only a limited number of community agencies with viable mentoring pro- grams. See response to items 5b and 5 c above.
R5:
The directors of DCFS, Probation, DMH, and LACOE should design and im- plement jointly a curriculum that address- es practical educational skills for all chil- dren to better prepare them for independ- ence. Partially Implemented - July, 2012 LACOE will be out stationing eight Education Counselors in DCFS regional offices beginning December 2011 to better address educational needs and provide support to CSWs, youth and families. DCFS currently partners with Probation and DMH as part of a multi-disciplinary team to address needs of DCFS youth at risk of crossing over to Probation. DCFS Youth Development Services continues to provide Independent Living Assistance for T A Y youth and participates in collaborative meetings to add to the discussion about T AY educational needs from a program perspective. 5a. All programs should contain an iden- tified minimum level of understanding on the part of the recipients before the pro- gram is considered delivered. Partially Implemented - July, 2014 DCFS Education Consultants and LACOE Foster Youth Services Education Counselors work closely with the school districts to support the educational needs of many children served by DCFS. With Title IV-E Waiver funds, the Gloria Molina Foster Youth Education Program will be expanded throughout Los Angeles County and will include out stationing children's social work- ers in the schools and working with community agencies to provide academic remediation ser- vices for DCFS youth. 5b. Enhanced study skills and courses on practical living skills should be part of the curriculum of juvenile halls and camps. DCFS should include such courses in the schedules of students at- tending public schools whenever possi- ble. Partially Implemented - July, 2014 In partnership with LACOE, the Education Coor- dinating Counsel and Probation, DCFS is imple- menting programs such as the Gloria Molina Foster Youth Education Program to better ad- dress and support the educational needs of DCFS youth. Additionally, DCFS works closely with several school based education programs in maximizing the number of DCFS youth participat- ing in after school enrichment and educational DCSF REVIEW – EXHIBIT 1-C 364 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 2007–2008 Item and Recommendation Status and Response programs. 5c. Foster children should be encour- aged to participate in music, art, and oth- er nonacademic programs. Probation should seek volunteers to provide these services in juvenile halls and camps. Partially Implemented - July, 2014 DCFS, in partnership with Los Angeles Unified School District, Education Coordinating Council, and several community programs is in the pro- cess of formulating a strategic plan to include identification of resources, outreach, and re- cruitment to support an increase of foster youth participating in after school and summer enrich- ment programs.
R6:
Under the leadership of the Deputy, CEO, DCFS, Probation, DPSS, and DMH, improve programs should be pro- vided to youth 18-25 who have left the system. Partially Implemented - On-going The Department continues to support this rec- ommendation and will utilize the CEO Self- Sufficiency Committee to address how this col- laboration towards an individual TA Y plan can be accomplished. It should be noted that the Exit Outcomes Report (State Soc405E) requires the DCFS case manager to provide information of TAY including the area of DPSS resources and DMH services up to their exiting DCFS jurisdic- tion.
R7:
Under the leadership of the Deputy CEO, DCFS, Probation, and DMH, in consultation with LACOE and other school districts, should develop a plan and a timetable for a comprehensive in- formation system to capture all records on all children in the system. The plan should include: cost estimates to develop and operate the system, a proposal for funding, and a timetable for implementa- tion should be reported every four months to the Board of Supervisors. Partially Implemented - July, 2014 DCFS worked with LACOE, Sacramento Office of Education, the Stuart Foundation and the Po- mona and Pasadena Unified School District to explore acquiring the Foster Focus Data Educa- tion Data Base System as a means to upload information from school districts and LACOE into one central data base containing all pertinent ed- ucation records for foster youth. The feasibility of implementing this system in LA County is still being explored. There have been no invitations extended to par- ticipate in any meetings convened by the CIO/CEO on this initiative. Limited information has been shared regarding this item. DCSF REVIEW – EXHIBIT 1-C 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 365 EXHIBIT 1-D - STATUS OF RECOMMENDATIONS – 2006-2007 2006–2007 Item and Recommendation Status and Response Juvenile Custodies – Are We Paying Twice? 1, 2, 3, Implemented Crisis in Communication – Preventing Child Fatality and Maltreatment 1.1, 1.2, 1.4, 2.2, 3.3, 3.6, 3.8, Implemented 1.3. Provide reports on a regular basis such as monthly to DHS hospitals on the outcome of all child maltreatment reports filed for each hospital and other reporting facilities. The Department disagreed with the recommen- dation in our initial response. 2.1. Implement mHUB and myCSW links between 1) all medical HUBS 2) medical HUBS and DCFS. Further assessment of CHEERS may be useful for inclusion of education and emancipation information in the countywide database. Partially Implemented - July, 2012 A direct electronic link between the myCSW and E-mHub systems could place the County out of compliance with Federal regulations relating to the State CWS/CMS. However, DCFS, Depart- ment of Health Services (DHS) and the Chief In- formation Officer (CIO) are working together to develop a solution. DHS and the CIO will make a joint recommendation to the CEO. DHS implemented the E-mHub patient infor- mation web-based system in March 2011 at all Medical Hubs. An electronic interface with DCFS is included and implements referrals going elec- tronically to E-mHub and through the interface, appointments status alerts and examination re- sults being received at DCFS. 3.2. Assign Public Health Nurses to staff the HUB clinics in addition to Children's Social Workers since all children in the DCFS system are already assigned a so- cial worker who could serve on the multi- disciplinary teams for the children on their caseload. Partially Implemented - February 2012 DCFS and DHS have pursued opportunities to identify funding by working with the County Chief Executive (CEO) Office. In the Fall of 2011, a specific funding source was identified to imple- ment the out-stationing of CSWs and PHNs at the Medical Hub. A proposal awaits review and approval from the BOS. 3.7. Assist ICAN in its integration efforts by incorporating it into DCFS so that it can continue to maintain its ongoing re- view of child deaths. The Department disagreed with the recommen- dation in our initial response. DCSF REVIEW – EXHIBIT 1-C 366 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 2006–2007 Item and Recommendation Status and Response 4.4. Consider an alternative system of medical record data entry, such as using Intermediate Typist Clerks or a similar County classification for the majority of routine cases so that Public Health Nurs- es are utilized in a more efficient and ef- fective manner but would still be available for assisting with interpretations of the more complex medical information and records obtained by DCFS for entry into CWS/CMS. Not Implemented - July, 2012 Once budget constraints are alleviated, DCFS will work with the CEO to identify possible fund- ing for this purpose. Triple Jeopardy – Abandoned, Neglected, and Abused Children of Los Angeles County 2, 2.1, 2.2, 3, 3.2, 4, 4.2, 4.3, 4.4, 4.5, 6, 6.2, 6.5, 7, 9.2, 10 Implemented 3.1. DCFS should develop new catego- ries of Foster Family Care that will have the skills and ability to parent the more challenging dependents currently placed in home facilities. Partially Implemented - December, 2012 In partnership with the Department of Mental Health (DMH), DCFS has executed contracts with 12 eligible Foster Family Agencies (FFA) for Intensive Treatment Foster Care (ITFC) and four FFAs for Multidimensional Treatment Foster Care (MTFC). The goal is to have 220 ITFC slots and 80 MTFC slots by the end of 2012. As of October 31, 2011 , there were 97 slots. MTFC is an evidence-based model of therapeutic foster care that has been rigorously evaluated in multi- ple studies with demonstrated success in provid- ing positive outcomes for youth in out-of-home care. MTFC limits the number of children placed in a foster home to one, and provides extensive training for foster parents; therapeutic interven- tions for the child, their family, and foster parents; along with round the clock crisis stabilization. ITFC is a more flexible framework outlined in the Welfare and Institutions Code 18358 and allows up to two children (e .g., siblings) to be placed in an extensively trained foster home and receive in-home mental health services that include Trauma-Focused Cognitive Behavioral Therapy. ITFC is not conditioned on family availability as a permanency resource. Therefore, youth with his- tories of placement instability and unmet mental health needs that interfere with permanency benefit from a homebased setting designed to meet these needs, as well as enhancing the po- DCSF REVIEW – EXHIBIT 1-C 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 367 2006–2007 Item and Recommendation Status and Response tential for finding a permanent caregiver. ITFC programs exist in several other counties in Cali- fornia and are considered a valuable and effec- tive alternative to group home placements. Currently, DCFS is undergoing a re-design of the D-Rate program that will build-in more support and guidance for the D-Rate foster parent. One of several actions stemming from this re-design is a DCFS and DMH work group that has begun exploring ways to extend a blend of the best practices found in treatment foster care and Wraparound to the D-Rate children and foster parents. The goal is to enhance the support and training of the D-Rate foster parents as well as the behavioral and mental health interventions for the D-Rate youth. 4.1. DCFS and Probation should develop a comprehensive and integrated, auto- mated information system containing all record and, reports that have been com- piled on every child by all caregivers. Not Applicable The Probation Department now has access to this information through CWS/CMS. 6.1. DCFS should implement assess- ment centers in existing residential-based facilities that have the qualifications, ca- pabilities, and capacity to provide such services. Not Implemented - To Be Determined We are still considering assessment centers. Currently CDSS has issued a moratorium on the acceptance and processing of group home rate applications that will be in effect until December 31, 2012. This includes a moratorium on the de- velopment of new programs, new providers, pro- gram changes (such as the RCL level) and pro- gram capacity increases. This moratorium will end on January 1, 2013 unless the date is ex- tended. (Please note that the moratorium began in October 2010 and was scheduled to end in October 2011, but was extended though Decem- ber 2012). 6.3. As part of the assessment process, DCFS and Probation should set goals, measure the effectiveness of their place- ments, and identify causes for ineffective placements or outcomes. Partially Implemented - To Be Determined On December 2, 2010 DCFS and DMH imple- mented a two-year pilot called Residentially- Based Services (RBS). RBS envisions shorter group home stays, and better outcomes with cost neutrality for the County. The pilot will provide empirical and fiscal data that will support the de- sign for potential countywide implementation. DCSF REVIEW – EXHIBIT 1-C 368 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 2006–2007 Item and Recommendation Status and Response 6.4. DCFS and Probation should assess and develop new strategies for their re- spective AWOL dependents and wards. Partially Implemented - On-going Our Countywide Runaway Outreach Unit (ROU) Program is currently providing services for 398 youth. The ROU CSW is utilized as a resource and secondary service provider to locate and stabilize youth, and reduce the recidivism of run- ning away episodes. The CSW works with the more hardened youth population that lives out- side the scope of established policies and proto- cols. The ROU is incident driven and immediate placement stabilization that can make long term planning possible. In 2010 a meeting was held between the DCFS ROU Program Manager and Probation to discuss Probation's development of a "Probation" ROU program. However, Probation reported having a lack of resources to implement a similar program. The DCFS ROU supervisor participates in a workgroup with DCFS, Court, Probation, and Mental Health to address the needs of At-Risk youth and cross-over youth.
R8:
DCFS should consider the employ- ment of additional Human Services Aides to alleviate some of the less critical work performed by the social workers. Partially Implemented - July, 2012 It is the Department's objective to assign one HSA to each CSW unit. However, this objective is still in the discussion stage. Human Resources and Budget personnel are discussing this topic. However, formal discus- sions with CEO staff must occur to identify fund- ing prior to formulating an implementation plan. The meeting with CEO staff will be scheduled during the first quarter of 2012. DCSF REVIEW – EXHIBIT 1-B 356 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXHIBIT 1-B - STATUS OF RECOMMENDATIONS – 2008-2009 2008–2009 Item and Recommendation Status and Response Policy vs. Results – Youth Employment Programs Funded but Not Fully Utilized 2.1.3, 2.2.2, 2.2.3, 3.1.3, 3.2.1 Implemented Hub Clinics – An Underutilized Resource 2.1, 2.2, 3.3.2, 3.4, 5.1.1, 5.1.2, 5.2, 5.3.1, 5.3.2 Implemented 3.1. The Director of DCFS should direct the CSWs and PHNs to create age- specific information sheets to be given to foster parents or caregivers at the time the detained child is placed in their care. These sheets should be sized for easy access, such as for positing on a refriger- ator or note-board, and give information listing normal behavior and expectations and also what steps should be taken in emergencies. Not Applicable A workgroup was convened to explore how to best implement the recommendation. It was de- termined that multiple individual versions would need to be developed in order to provide the caregiver with the specific and appropriate age- specific information for each child in their house- hold as no single age-specific document would meet the needs for all children in their household. Foster parents must be CPR certified, mandated 16 hours of pre-service hours to become certified as foster parents and required a designated number of hours yearly training hours to maintain their foster care certification. The purpose of the caregiver classes is to provide them with the knowledge and tools to assist them in meeting the needs of the foster care population, including child development, behavioral issues, social ser- vice benefits, etc. Detained children continue to receive an initial physical exam at the Hubs and caregivers are educated on developmental issues at the time of the exam. For subsequent well child exams, CHDP providers provide developmental, age- specific, anticipatory guidance to the caregivers. Foster children are mandated to receive routine well-child visits including developmental screen- ing and developmental, age-specific anticipatory guidance by a CHDP Provider on a regular basis and, as such, this recommendation is no longer applicable. 3.2. The Directors of DCFS and DHS should, by the end of 2009, develop crite- ria or identifying children in the child wel- fare system for whom the HUB Clinics Not Implemented - Unable to provide a target date for completion due to budgetary constraints. DCFS agrees with this recommendation, but has deferred any plans to expand Medical Hub ser- DCSF REVIEW – EXHIBIT 1-B 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 357 2008–2009 Item and Recommendation Status and Response should serve as medical home, with re- sponsibility for their overall medical care coordination, focusing on those with spe- cial health care needs and sexual abuse victims. vices as we focus on meeting the service needs of the priority populations of newly detained chil- dren and children requiring forensic evaluations.
➢ DHS Administration has a heightened level of interest in establishing medical homes and continuity of care services for DCFS children and has initiated further discus- sions with DCFS on how this can be real- ized.
➢ Per DHS, as more revenue is identified and realized to cover the cost of the services that are provided to DCFS children by the Hubs, it is possible that additional funds could be made available to serve our chil- dren, such as expanding the Hubs as med- ical homes for all children.
➢ The Board of Supervisors has requested that DHS maximize the revenue related to the costs of the Medical Hub operations. DHS is pursuing this diligently. For exam- ple, DHS and LA Care Health Plan, one of the County's two Medi-Cal Managed Care Plans, are finalizing a partnership whereby LA Care will contribute a portion, albeit small, of the costs for the forensic evalua- tion and initial medical exam for children who are LA Care Plan members referred to DCFS to, and served by, the Hubs. 3.3.1. The Directors of DCFS and DHS should, by the end of 2009, develop crite- ria for children in the child welfare system for whom the HUB Clinics would not serve as medical home, but should pro- vide continuity of care by:
• Periodic reassessments every six months.
• Case reviews of children with spe- cial health care needs who are be- ing seen by private community pro- viders.
• Those at risk of being victims of abuse again, such as when chang- es in placement occur.
• Those under the Family Mainte- nance program, still living in homes where they were abused. Not implemented - Unable to provide a target date for completion due to budgetary constraints. See Response to 3.2 above. DCSF REVIEW – EXHIBIT 1-B 358 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 2008–2009 Item and Recommendation Status and Response 4.2. The Directors of DHS and DCFS should work in collaboration with the County CEO and CIO to develop a long- term data and information-sharing system by June 2011 that enables these depart- ments and others involved with serving foster children and youth to access key information about children's health and mental health needs and case histories. Partially Implemented - 1st phase November, 2013 DCFS is working with the DHS, DMH and Chief Executive Office for the implementation of the Enterprise Master Person Index (EMPI). The EMPI will identity common clients of County ser- vices to facilitate the secured sharing of infor- mation for improving services and coordinating service delivery. The EMPI will facilitate identifi- cation of common clients, and when it is legally permissible to do so, will facilitate appropriate, accurate, and reliable sharing of client data. 4.3.1. The Directors of DCFS and the DPH should proceed with implementing the Lakewood project model system wide, enabling PHNs to work on any of the cas- es that come into the office to which they are assigned, regardless of department affiliation. Unable to Implement The CEO researched funding sources for the Project, but any additional funding would require the Board's approval. Mr. Wesley Ford, Director for Children's Medical Services, has agreed to implement the Lakewood Project county wide if DCFS provides the lost revenue that would occur under the existing HCPCFC funding structure at the Federal and State level. Due to DCFS budgetary constraints, DCFS will not be able to provide DPH with their lost revenue and, as such, we are unable to im- plement this recommendation. 4.3.2. The Directors of DCFS and the DPH should collaborate to implement de- partment-wide the DCFS Lakewood Pro- ject pilot integrating the two departments' PHNs by the end of 2009. This will re- quire DCFS to utilize Katie A. funding in the short run for the estimated 15% of PHN time that would be not covered by the State CHDP funding, and identifying funding for long-term implementation. Unable to Implement Please refer to 4.3.1 above. 4.3.3. The Directors of DCFS and the DPH should research and work to resolve the funding issues introduced by the Lakewood project and the recommended organizational structure change by the end of 2009. This may be done by apply- ing for additional funding and /or a waiver Unable to Implement DCFS has explored funding with DPH, CHDP and Title IV-E Waiver dollars. However, due to DPH, Health Care Program for Children in Foster Care (HCPCFC) strict funding restrictions, this recommendation is not feasible. Please refer to DCSF REVIEW – EXHIBIT 1-B 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 359 2008–2009 Item and Recommendation Status and Response through the CHDP program. It also may involve identifying other DCFS funds to cover any balance not covered CHDP. 4.3.1 above. 4.3.4. The Directors of DCFS and the DPH should revise the MOU between DCFS and DPH by the end of 2009 to provide for input by DCFS Regional Man- agers into the evaluation process for DPH PHNs. In Progress - Mid 2012 DCFS will pursue the request for this recommen- dation during the process of the MOU's periodic, bi-annual review in mid 2012. Regional Adminis- trators (RAs) continue to have the option of providing input to either the PHNs or Nursing Manager about the performance of PHNs. 4.4. The Directors of DCFS and the DPH should finalize and proceed with tracking caseload and outcomes to evaluate indi- vidual PHNs and overall effectiveness of their services In Progress - April, 2012 A committee comprised of representatives from DPH Children’s Medical Services (CMS) Admin- istration, Information Section and Health Care Program for Children in Foster Care (HCPCFC) Nurse Manager, DCFS BIS, Public Health Nurs- es (PHN) Program, and County Counsel met to identify data elements for tracking Public Health Nurses caseloads. Policy is being drafted on adding PHNs as “Secondary” on referrals and cases. PHN Supervisors are providing staff with training on policy. Health Information-sharing for At-risk Youth – Overcoming Obstacles 2.1, 2.2, 3.5, Implemented 6.1. To the extent permitted by law, DCFS, DHS, DMH and DPH should pro- vide skilled healthcare professionals ac- cess to a youth's healthcare information regardless of the department in which the information was originally obtained. The Department disagreed with the recommen- dation in our initial response. 7.1.1. The CEO should caucus with DCFS and DMH, as well as with the DCEO of the CFWBC and County Coun- sel, to develop strategies for implementa- tion of standards, remedies, and legisla- tive changes at both County, State and Federal levels that will enable continuing improvements of healthcare delivery to County residents, consistent with the im- provements which have been achieved as a result of Katie A Court and Advisory In Progress - To be determined This recommendation has been forwarded to the CEO as the lead. We have also referred to DHS as they, along with DPH, will need to take the lead on the major activities due to pending Healthcare reform. We will also work toward de- velopment of a workgroup comprised of CEO, DMH and DCFS to consider some legal reme- dies, but this level of strategic development and implementation of standards, remedies, and leg- islative changes at both County, State and Fed- DCSF REVIEW – EXHIBIT 1-B 360 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 2008–2009 Item and Recommendation Status and Response Panel supervision. eral levels that will enable continuing improve- ments of healthcare delivery to County residents, consistent with the improvements which have been achieved as a result of Katie A Court and Advisory Panel supervision has not been consid- ered. 7.2. The CEO should work with DCFS and DHS to develop written assurances from the State that County actions taken in response to Katie A. rulings are contin- ued response to Katie A. rulings are con- tinued beyond the expiration of the Fed- eral court order(s). In Progress - On-going Los Angeles County is in the 3rd year of imple- menting its 5 year Katie A. Strategic Plan. This plan and court oversight are not expected to ex- pire until 2012. Los Angeles County DCFS and DMH representatives participate in the weekly Negotiation Workgroup and continue to monitor the progress of the State's portion of the Katie A. lawsuit and advocate for changes at the State level that are consistent with Los Angeles County positions and activities with regard to the Coun- ty's settlement activities. Los Angeles County remains engaged with the Katie A Panel and exit criteria from the Katie A Settlement Agreement which were agreed upon in 2011. These criteria include provisions that require Los Angeles County to sustain the initiatives and practice changes that are achieved through the Settle- ment Agreement. Be Prepared - Keeping Kids Save – Disaster Preparedness for Youth in County Custody
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DCFS and Probation should strategi- cally use congregate care facilities that meet quality assurance standards and provide awards for achieving meaningful outcomes. Partially Implemented - July, 2012 DCFS has met with the Probation Department on monitoring the quality of care and service deliv- ery congregate care facilities provide to place youth. As these discussions move forward, plans will be underway to determine how to best acknowledge providers who achieve meaningful outcomes. 9.1. DCFS and Probation should study how best to improve group home facili- ties’ programs, staffing skills and staffing levels. Partially Implemented - To Be Determined On December 2, 2010, DCFS and DMH imple- mented a two-year demonstration pilot called Residentially Based Services (RBS). The data to date show promise, but it is too early to decide on effectiveness or expansion. The vision is for RBS to be the new model for group home care with an emphasis on permanency and creative strategies to move youth safely back into the community as quickly as possible with no recidi- vism. DCFS REVIEW – EXHIBIT 2 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 369 EXHIBIT 2 – UPDATED STATUS – GRAND JURY REPORTS 2006 – 2010 The following provides the status of the recommendations made in the 2006 through 2010 Civil Grand Jury Reports. The Department of Children and Family Services (DCFS) has implemented 75 of the 121 recommendations and made significant pro- gress in the remainder. Each year is summarized for easy review. 2009 – 2010 Child Abuse Reporting and Response Report The Grand Jury's review was precipitated by the implementation of a system to speed up and standardize the reporting of and response to Suspected Child Abuse Reports to law enforcement agencies. The Grand Jury made recommendations to strengthen and formalize the interfaces among responding agencies. There were a total of eight rec- ommendations of which five have been fully implemented and three are partially imple- mented (see Exhibit 1-A). We have highlighted some of our accomplishments, as fol- lows: We have fully implemented the Electronic Suspected Child Abuse Report (E-SCAR) system, and we meet regularly with law enforcement partners. We also developed a draft Memorandum of Understanding (MOU) however, given the development of various enhancements to the E-SCAR system, it has not been finalized. We anticipate the MOU will be finalized by January 2012. DCFS Social workers are co-located in seven of 21 Los Angeles Police Department (LAPD) stations, six of 23 Los Angeles Sheriff Department (LASD) Agencies, and six of 46 independently run law enforcement agen- cies. We have updated our MOU with LASD and are drafting an Operational Agree- ment with the Independent Agencies to ensure uniformity and best practice. We are in full agreement that co-location of social workers at law enforcement facilities will help promote better communication and will continue working with our partners to strengthen our partnerships. 2008 – 2009 The Plight of At-Risk Youth in Los Angeles County Report The Grand Jury Report details the findings following in-depth reviews of eight areas of County departments that may have answers to the reasons for the number of youth gang members, number of children in foster care, and number of children who drop out of school. Some of the areas investigated were youth employment programs and ser- vices in Los Angeles County and its municipalities, County Hub Clinics providing medi- cal services for children in the child welfare system, information technology and imped- iments to information sharing among agencies serving at-risk youth, and extending the age of emancipation for foster care. The Grand Jury directed 33 recommendations to DCFS of which 20 have been implemented; six are either in progress or partially imple- mented; two have not been implemented; one is no longer applicable; we are unable to implement three recommendations we disagreed with one recommendation (item 6.1) in our original response (see Exhibit 1-B). We have implemented all the recommendations which addressed youth employment programs and services and AB 12. In summary, we implemented a Career Develop- DCFS REVIEW – EXHIBIT 2 370 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT ment Intern Program and, although there have been some fiscal limitations which have
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