2003-2004 Final Report

Recommendations 11

• R1

  Page 19
  The Grand Jury recommends that Humboldt County and the cities of Blue Lake, Eureka, Ferndale, Rio Dell, and Trinidad review available model ethics codes and adopt their own codes of ethics, to apply to all officials, elected and appointed.
• R2

  Page 19
  The Grand Jury recommends that the City of Fortuna review available model ethics codes and adopt its own code of ethics, to apply to all officials, elected and appointed.
• R3

  Page 20
  The Grand Jury recommends that the City of Arcata review other available model codes of ethics and consider modifying or supplementing its current Code of Ethics in accordance therewith.
• R4

  Page 20
  The Grand Jury recommends that Humboldt County and the cities of Arcata, Blue Lake, Eureka, Ferndale, Fortuna, Rio Dell and Trinidad include citizen participation in the development (or, in the case of Arcata, modification or supplementation) of their codes of ethics.
• R5

  Page 20
  The Grand Jury recommends that the County Administrative Office regularly sponsor ethics workshops and expand the invitation list to include all elected and appointed city and county officials. Grand Jury Report #2004-AF-02 GRAND JURY ACCESS TO ADULT PROTECTIVE SERVICES FILES WHO SHALL RESPOND: Pursuant to California Penal Code Sections 933 and 933.05, responses to the Findings and Recommendations of Grand Jury Report #2004-AF-02 shall be provided as follows: • The Humboldt County Counsel shall respond to Findings and Recommendations 1 and 2. • The Humboldt County Department of Health and Human Services shall respond to Finding and Recommendation 2. The Grand Jury is one of the “clients’ to whom Humboldt County Counsel provides legal advice. Its other “clients” include the county and its various departments, which are subject to investigation by the Grand Jury pursuant to the Grand Jury’s “watchdog” function. A prior Grand Jury received a complaint regarding the death of a disabled person who was receiving services from the county’s Adult Protective Services Division (APS). APS is part of the Social Services Branch of the Department of Health and Human Services (DHHS). The Grand Jury wrote a letter requesting the APS file on the deceased. In response, the Director of Mental Health, another branch of DHHS, refused to provide the APS file over which it had control. APS staff was also instructed not to answer questions about the case. The Director contended that this information was confidential pursuant to Welfare and Institutions Code Section 10850, and could not be obtained by the Grand Jury despite its investigative authority. The prior Grand Jury turned to County Counsel for assistance in obtaining the file and examining witnesses. However, County Counsel simply agreed with the Director of Mental Health regarding the confidentiality of the information. County Counsel gave no explanation for its position, did not mention the legal authorities that are inconsistent with its position, and did not suggest to the Grand Jury that there might be procedures available to obtain the file other than a letter request. These events were the subject of a prior Grand Jury Report, in which the Grand Jury recommended that County Counsel reconsider its interpretation of the confidentiality provisions of Welfare and Institutions Code Section 10850 in the context of a Grand Jury investigation. County Counsel refused, stating in 20 response that “The recommendation will not be implemented because it is not warranted.” This year, the 2003-2004 Grand Jury also decided to investigate APS’s handling of the deceased person’s case and turned to the District Attorney’s office for assistance. The District Attorney’s office quickly obtained subpoenas and a court order that required APS to produce the deceased client’s file and required APS and other DHHS staff to testify regarding the case. The subpoenas and court order were served, the APS file was produced, and the witnesses testified before the Grand Jury without further objection. It is the opinion of this Grand Jury that the earlier investigation was derailed because County Counsel did not advocate for the right of one “client” (the Grand Jury) over the interests of another (APS), frustrating an investigation contemplated by the laws which establish, govern, and empower that “client.” This is unacceptable. The Grand Jury is composed of 19 ordinary citizens from diverse backgrounds who volunteer to serve a one-year term. Typically, they have no formal training or education in legal matters and, at times, must rely on the expertise of their advisers, including County Counsel, to fulfill their responsibilities to the citizens of Humboldt County. DHHS has acknowledged the Grand Jury’s right to obtain information about the handling of APS cases by its responsiveness to the subpoenas and court order that were served. County Counsel should acknowledge that right, as well. Both entities should take steps to insure that future Grand Juries do not have to reinvent this wheel.
• R6

  Page 33
  The Grand Jury recommends that DHHS discontinue use of taxpayer dollars to pay caregivers who are not providing the levels of care approved for the client, particularly when physical, emotional, or financial abuse is involved.
• R7

  Page 33
  The Grand Jury recommends that a centralized system for cross-checking and verifying each caregiver’s cumulative timecard hours and verifying client timecard signature be established.
• R8

  Page 33
  The Grand Jury recommends that when a caregiver’s fraud has been legally confirmed, that caregiver be permanently disqualified as a caregiver in Humboldt County.
• R9

  Page 33
  The Grand Jury recommends that a cross-file of shared cases be instituted so that APS and IHSS caseworkers have access to information and status of an individual’s case within the other division. When the status of a case is shared, caseworkers and supervisors from both divisions should be included in a multi-disciplinary decision-making team. APS caseworkers whose clients are also IHSS recipients should assist IHSS by verifying authorized caregiver services during regular visits to the client and reporting findings to IHSS.
• R10

  Page 33
  The Grand Jury recommends that HCSD develop a written policy and establish procedures for mandatory reporting of abuse and welfare checks, including requirement for the documentation of deputy visits and findings immediately following those visits.
• R11

  Page 33
  The Grand Jury recommends that, when the new policy and procedures have been developed, annual mandatory training in the newly established policy and procedures regarding mandated reporting of abuse and welfare checks be instituted and a documented record of attendees maintained. Grand Jury Report #2004-HS-02 HUMBOLDT COUNTY’S FOSTER CARE PROGRAM NEEDS HELP NOW WHO SHALL RESPOND: Pursuant to California Penal Code Section 933 and 933.05, responses to the Findings and Recommendations of GRAND JURY REPORT #2004-HS-02 shall be provided as follows: • The Humboldt County Department of Health and Human Services shall respond to Findings and Recommendations 1 through 11. In 1999 the Little Hoover Commission, an independent state agency charged with recommending ways to increase efficiency and effectiveness in state programs, issued a report on California’s foster care system, which outlined a comprehensive strategy for reform. In 2003, the Commission weighed in again by 33 issuing a press release stating, “Three years have passed, but almost no progress has been made in reforming…[the] foster care system.” As a result, the California legislature adopted Assembly Bill 636 to bring serious focus to reform. Humboldt County is one of the eleven California counties currently engaged in pilot projects to redesign the state’s foster care system. The county will receive over two million dollars in the next four years to support its efforts at reform. The 2003-2004 Grand Jury received a complaint regarding Humboldt County’s Child Welfare Service (CWS), a division of the Department of Health and Human Services (DHHS). A local medical professional alleged serious shortcoming in the foster care program which he believed had adversely affected one particular family. Because of this complaint and other concerns about the county’s foster care program, the Grand Jury investigated how the local program works for children and families. The investigation spanned July 2003 to April 2004 and included sixteen interviews of foster parents, current and former caseworkers, supervisors, and agency, medical, and court personnel. Jurors made two unscheduled facility visits, distributed surveys to 21 medical professionals, and reviewed numerous documents. DHHS asserts that its mission is “to protect children from abuse, neglect and exploitation and to promote the health, safety and nurturing of children…” The Grand Jury found serious deficiencies in the way this mission is being fulfilled. Although the redesign pilot project is underway in the county, foster children, foster parents, and the system itself need help now. Personnel The Grand Jury’s investigation revealed that CWS is in a constant state of flux with an inordinate amount of caseworker turnover. Promotions, resignations, medical leaves (often stress-related), and employees rotating in and out of jobs have created turmoil and uncertainty for foster children and families. An independent California study demonstrated that “Most social workers’ caseloads are … too high for them to meet all the requirements of the job.” Certainly, that is true in Humboldt County. Although state guidelines recommend caseloads of no more than 15 in the Family Maintenance and Family Reunification units, local caseloads currently stand at about 26-27. There are approximately ten vacant caseworker positions – out of 70 allocated – in the department. Excessive overloading of cases creates major problems in caseworkers’ ability to deal with the children and families in their charge. A caseworker is expected to see each foster child and meet with the foster parent once a month. This is often not possible with the almost double caseloads currently being carried by CWS caseworkers. Therefore, they resort to telephoning families or sending forms to be completed rather than making in-person visits. These methods are of limited value for determining the actual condition of the child, the foster parents, or the foster home. In addition, about a year ago, overtime in the department was eliminated. Caseworkers sometimes make evening and/or weekend visits on their own time in order to find people at home or to be able to complete their required tasks. They are “on-call” to handle after-hours reports of abuse or neglect a minimum of ten times a year. Testimony revealed that this further impacts caseworker effectiveness and morale. Departmental training for caseworkers is inconsistent. Some training is on-the-job, some is based on computerized programs, and some is conducted by first-level supervisors. Core classes are provided annually for new hires through U.C. Davis. Even specialized training that is offered is not mandatory. There is no ongoing mandatory training, for example, in stabilized case management, conflict resolution, or preparation for court appearances. Currently, for every five to eight caseworkers, there is a first-level supervisor. This represents an increase in the number of supervisors over the past two years, while the number of programs has increased and the number of caseworkers has decreased. In spite of the fact that caseworkers are most familiar with family situations, their recommendations are often overruled by supervisors who do not meet with children and families. There is little opportunity for team decision-making or consensus-building in case management. First-level supervisors are generally 34 available and supportive to caseworkers, but caseworker communication with supervisors at the second, third, fourth, and fifth (top) levels are discouraged. This chain of command has created tension within the department. Resignations, early retirements, and stress leaves have decimated the department’s staff, and caseworker morale is extremely low. Children and Families Social, emotional, and developmental costs to children in the foster care system are profound. Many have birth parents burdened with substance abuse, domestic violence, or mental health problems which create an environment of chronic fear and neglect. When children have experienced removal from birth parents, they need new adults in their lives who are stable and consistent. Grand Jury investigation indicates that this is not happening for many foster children. From the moment of intake into the system or placement in a foster home, children experience a series of changing caseworkers, foster parents, and therapists, which adds to a child’s feelings of insecurity. Too often these are paperwork transfers without personal knowledge, insights, or concerns passed on to the next caseworker or foster family. Also, the Grand Jury was told by witnesses that some of the moves from one foster home to another are due to conflicts between CWS and the foster parents. Children’s wishes are not necessarily considered. Oftentimes siblings are split between foster homes. Frequent moves have a negative effect on children’s schooling, create disruptions in medical care, and cause lack of continuity in parenting. Efforts to reunify families and to assist in maintaining the reunified family also fall within CWS’ responsibility. The Family Reunification unit has a maximum of 18 months to return children to their biological parents. The Family Maintenance unit has a maximum of 12 months to determine a family’s progress. During these time periods, CWS provides visitation for parents with their removed children as well as parental training to correct the behaviors which led to the children’s removal. This training usually consists of nothing more than the parents’ attendance at several weekly parenting classes. Foster Families Testimony revealed a major shortage of foster homes in Humboldt County and consistently attributed that shortage to department policies and practices. The number of foster homes licensed in the county varies from 100 to 125. Recruitment seems difficult because of tension between CWS personnel and some foster parents. Some foster homes have spaces available which are not being utilized due to conflicts with the department, while children may wait for weeks for a placement. In many cases they are held in the emergency shelter beyond the 30-day limit. A CWS supervisor may remove a child from a foster home even when the caseworker believes the placement is successful. CWS and foster parents alike need training in conflict resolution and sensitivity. Because of the extreme need for foster homes, Humboldt County has entered into contractual agreements with two private agencies to provide them. This type of private agency placement does relieve some of the CWS caseworkers’ responsibilities, such as the monthly visits. Foster parents receive 12 hours of training annually through College of the Redwoods. However, insufficient numbers of foster parents are prepared to deal with children with extreme behaviors. Standard foster care homes may accept no more than six children; those designated as therapeutic foster care (TFC) homes are limited to a maximum of two children with extreme physical and emotional problems. Reductions in the number of children with TFC designations, which have higher than standard reimbursement rates, are being made without consultation with foster parents. Testimony indicated this is an attempt by CWS to save money. A Family Intervention Team (FIT) now makes decisions regarding placement of the most difficult cases without consulting the caseworker, the child, the family, or the foster parent. Witnesses testified that decisions are made with regard to money, not to the needs of TFC children. Foster parents are supposed to receive a Health and Education Passport when a foster child enters their home. This Passport is meant to convey relevant background information about the child, not only to help 35 the foster parents understand and work more effectively with the child, but to warn of potential problems. Foster parents do not always receive this Passport. Oftentimes when they do, its information is incomplete or out-of-date. When that happens, the foster parent is unable to prepare adequately for potential problems such as fire starting, sexual deviance, et cetera. Services Foster children need expert mental health services, not necessarily the cheapest. Children who are extremely disturbed, dysfunctional, or violent need specialized therapies and care. Instead, over the past three years, services to children and families have been severely cut. Even for the high-risk TFC child, the majority of mental health services are made available through the Children, Youth, and Family Services units of the Department of Mental Health. They are provided by a rotating contingent of interns. One Licensed Clinical Social Worker oversees about ten interns who work directly with children. Interns may see the child one hour per week, which may not be adequate for high-risk children. The child may see four to six interns over a two-year span. CWS will not or cannot pay professional private therapists who do not accept MediCal. Dental care is also a problem for foster children because too few dentists accept MediCal and, again, CWS avoids paying non-MediCal rates. It may take weeks for caseworkers to obtain supervisory approval for any services or expenditures. The Grand Jury received information that CWS does not always follow medical doctors’ opinions and recommendations; see attached results of the medical professionals’ survey. Even when services are court-ordered, CWS does not always provide funding for them. Sometimes CWS disregards a judge’s order rather than going back to court to request modification. Court Procedures Continuances often result from caseworkers being unprepared, absent, or untrained in court protocol. This slows the process to the point where a child and family may be held in limbo for months without resolution of their issues. Finally, there can be a lack of consistency in how families are dealt with from the pre-court stage through the court process. This apparently stems, at least in part, from the fact that CWS both investigates and files the case. Medical Professionals Survey Results (13 respondents of 21 pediatricians surveyed)* Rate your professional relationship with: Poor Adequate Good Excellent CWS 3 5 1 Foster Parents - - 9 4 Rate CWS’ responsiveness to your: Professional 7 2 1 1 Opinion Recommendations 7 2 1 1 Children’s Needs 5 6 1 1 Foster Parents’ Needs 4 5 3 1 Have your diagnoses/ Yes No Sometimes treatment plans been respected/followed by: CWS 2 1 5 Foster Parents 7 - 2 *Not all respondents answered every question. Summaries of Medical Community Comments: 1. CWS seems reluctant to open and carry cases, or they close them before it is safe. 2. CWS has a tendency to not adequately investigate or not take action when it appears to be warranted. 3. I have been appalled. 4. CWS sends children to live in homes without heat, or the same home as a convicted child molester, or back to parents who injured them, or allows visitations in jail for infants. 5. I have stopped thinking that CWS referrals would actually help children who need it. 6. Most referrals I made were not investigated or I received a note saying my accusations were not substantiated. 7. Numerous medical staff recommendations that newborn babies be removed from birth mothers due to danger to their infants have been ignored, often resulting in severe neglect, injury, or even death of infants by the very parent CWS was warned about. Based on the foregoing, the Grand Jury makes the following findings and recommendations: