In Memory of Judge Stephen E. O’Neil Supervising Judge Johnnie Raines Los Angeles County Civil Grand Jury

Conclusions 14

• CL1 Page 59
  Hospitals having stroke centers as part of the medical landscape of Southern California would probably save lives and prevent and lessen disabilities following strokes. The County through its hospitals would probably save money by decreasing the length of patient’s hospital stays and the disabilities resulting from their strokes. Establishment of these centers is a daunting task. Work on this problem has been going on for some time. 49 Health & Human Services Committee STROKE CENTERS
• CL2 Page 119
  BRC Bridges to Recovery Program is a fairly new program, opened three years in July 2002. There have been a number of important changes and improvements in the program curriculum and operations throughout the program development. The conclusions below will continue to advance the Bridges Program towards formalizing the policies and procedures and documenting the program operations in order to determine successes and failures and continue to improve program operations. Although there is a general BRC Domestic Violence Program goal, reasonable and measurable, overall program objectives need to be developed; as well as specific guidelines or procedures for determining (a) how that overall goal will be achieved, and (b) how inmates and program staff know when the goal has been met. Objective criteria for successfully completing the program need to be developed and communicated to inmates and staff. Program outcomes need to be validated with pre- and post-testing of the participating inmates. A formal, state-approved course curriculum has been developed for Bridges program for each of the seven class groupings. The course description, class outlines, formal descriptions of goals and objectives and lesson plans are well documented; however, many of the course objectives are too broad and not measurable. Also, there is a need for a formalized process and documentation for determining if a student has successfully met all program objectives, and it is unclear how instructors know if students have successfully met class objectives. 133 Section 1: Program Curriculum and Operations There is no documentation or process for determining whether all potential BRC candidates are screened, or how many potential candidates qualify for the program. The Sheriff’s Department needs to develop tools to systematically assess and record admission decisions so that the domestic violence program can be adapted to inmate treatment needs. Formal criterion and processes for selection need to be developed. The bulleted list of selection criteria created for the audit, needs to include all criteria, including the offenses accepted. Program participation should be limited to individuals convicted of domestic violence related charges only, so that selection subjectivity by the intake officer is controlled. The selection criteria based on the time remaining on the inmate sentence needs to be formalized and more consistently applied. A formal and thorough assessment process needs to be developed by the HLPSD program staff in order to determine the appropriateness of each program participant and obstacles that may prevent effective treatment. The vast sentencing window of 6 weeks to 3 months should be limited to be as close to 6 weeks as possible, given the fact that the course is 6 weeks long. This would allow for additional inmates to participate in the program, rather than fewer inmates participating in the program for longer than the curriculum requires. The need for work trustees to run the facility should be analyzed to determine if the current program inmates could run the facility rather than accepting inmates with 3 months left in order make them trustees after they have graduated. This appears to be an inefficient use of program bed space. The BRC facility orientation process, conducted by the Sheriff’s Department is unstructured and not formalized, and the thoroughness of the orientation appears to be based on the preferences of the individuals conducting the orientation, guided by a brief checklist of items to cover. Formalized materials need to be developed so that each inmate receives the same level of orientation. The Bridges to Recovery program expectations and criteria should be incorporated into the Sheriff’s orientation process, creating a single, co-lead orientation between the Sheriff and HLPSD. A more in-depth assessment process can be conducted solely by HLPSD for determining program placement, limitations to program success, etc. Also, formal training for anyone who may conduct the orientation needs to be developed and implemented consistently for both the Sheriff’s staff and HLPSD. A more extensive and formal process for transitioning inmates into the community needs to be developed and supported by more than one part-time counselor. A curriculum should be developed and formally implemented, and contact with the LASD Community Transition Unit and Probation Department are essential if inmates are to successfully transition to the community. 134 Section 1: Program Curriculum and Operations
• CL3 Page 123
  A validated and complete unduplicated count of Bridges to Recovery program participants was not obtained due to the disparate data systems that track participants and the delayed responses to our participant profile data requests. Three samples were conducted to obtain snapshot profiles of the participant population, which found that demographic trends are generally consistent. The typical participant is Hispanic male, aged 35, with multiple offenses, prior arrests and convictions. The survey profile should be expanded to include all participants in the program, and the survey methodology should be improved to increase data reliability. Some elements of the survey could be captured more reliably from other sources. Further, a single source of information should be developed to track program participants. The BRC Student Records Database could be expanded to include additional profile data such as the information included in the BRC survey and Correctional Services Division recidivism study. The reasons for data omissions and errors need to be identified and analyzed to limit record inconsistencies. Of the 229 graduates analyzed for the Correctional Services Division March 2002 recidivism study, there were six graduates who attended the program based on “miscellaneous charges”. A comprehensive review of all charges should be conducted so that the program remains focussed on serving the targeted population. Based on a sample of BRC Student Records, we found that the average length of stay is quite long for the inmates who were released prior to graduating (78.2 days), or graduated but were released from custody after the graduation date (90.5 days). This demonstrates a need to track “drop” reasons, to develop a process for dealing with inmates who are not progressing through the program, and to define program goals and objectives for dealing with inmates who remain at the facility after successfully completing the program while awaiting his release. Because the program is based on a six-week curriculum (42 days), the average length of stay for graduates was twice as long as the length of the curriculum. To the extent program participants spend more time than required at the facility, other potential participants cannot be served. A review of the inmate selection process should be conducted to ensure that only those inmates are selected who have as close to six weeks remaining on their sentence as possible. The program objective of releasing each graduate directly from BRC and not having them return to general population can still be met if more care is taken at the front end when choosing the inmates for participation based on their length of time remaining in custody. 144 Section 2: Profile of Program Participants
• CL4 Page 132
  Analysis conducted for this study indicates that the average cost per inmate day is approximately $105, which is higher than in many of the County’s other jail facilities. Although recent analysis of the average cost in other facilities was not provided by the Sheriff’s Department, discussions with administrative managers indicate that it is as low as $50. The total Sheriff’s Department and Hacienda La Puente School District cost for operating the Biscailuz Recovery Center equals approximately $4.7 million per year for both the Bridges to Recovery and IMPACT programs. Because there is sufficient capacity to house the average daily population of 101 inmates in the County’s other jails, the costs to operate the Biscailuz Recovery Center represent a variable cost which could be nearly eliminated if the facility was closed. The average cost per inmate participant equals approximately $7,656 since program inception. The average cost per graduate equals approximately $12,985 during the same period. Because these high average costs are nearly all variable, it is incumbent upon the Sheriff to monitor costs closely and incorporate averages as measures of performance in any cost-benefit analysis it conducts of the Biscailuz Recovery Center Bridges to Recovery Program.
• CL5 Page 147
  This audit was unable to conduct an original analysis of program effectiveness and outcome data due the disparate data source systems and the continuously delayed responses to our data requests. We were unable to get a validated list of program participants and program graduates to track for recidivism analyses. Therefore, the recidivism analysis for this audit is based solely on a secondary review of two studies completed by the Sheriff’s Department Correctional Services Division. The Bridges Program understands the need to track and validate program success. Their first two recidivism studies reflected their understanding of this need. The Correctional Services Division is taking the lead role in beginning to look at program success issues and has reported the need to gather the appropriate data. Some initial steps are being taken in order to track recidivism and other non-quantifiable elements, such as social impacts to success. In order to measure program effectiveness and program success with any validity, however, quantifiable measures must be established based on program goals and objectives. In order for quantifiable measures to be developed, overall program goals and objectives must be determined and must be measurable. The Bridges to Recovery Program lacks measurable and reasonable objectives, methods for measurement, quantifiable performance and outcome indicators, and a consistent method of capturing performance data. Program effectiveness cannot be determined, even though an estimated 44% to 59% of program participants graduate. An extensive amount of additional data must be consistently captured for all participants in order to obtain a more comprehensive understanding of program results, such as why others did not graduate, release dates and release reasons. Based on a sample of 229 graduates, the Correctional Services Division Recidivism study of the BRC Bridges program found a 30 day recidivism re-arrest rate of 4.1% and a 1 year cumulative re-arrest rate of 32.71%. Again, these results are inconclusive since additional data, particularly re-arrest of specific domestic violence offense data must be captured and analyzed to confidently determine whether the program impacts the domestic violence behavior of participants. A notable pattern evident from analysis of the 229 graduate data is that graduates continue to be arrested and re-arrested at a fairly consistent rate for up to the year after graduation. This 161 Section 4: Program Results suggests that an aftercare program that is coordinated with the Probation Department may be appropriate.
• CL6 Page 196
  As the number of children at the Center has grown older and the number of children needing additional and special services has escalated, staff at MacLaren is faced with many difficult decisions regarding the child’s best interest. The Center handles a very troubled and difficult population that is getting older and is of very high need. A stronger mental health component to the core staffing at MacLaren is appropriate at this time. A proposal prepared by the Mental Health division to reconfigure cottage staffing to add more mental health professionals is a logical proposal for dealing with the population. A more comprehensive replacement of Children’s Social Workers and Group Supervisors with mental health staff is a preferred approach however because it would allow for introduction of a new more therapeutic approach to residential services and it could be done at lower cost.
• CL7 Page 205
  In general, the MacLaren administration has done a good job of bringing the facility into compliance with CDSS requirements to conduct background checks on new and existing employees. There are exceptions, however, and these include background checks conducted by LACOE, which are conducted in a different manner than those conducted by MacLaren, resulting in our inability to confirm that background checks were in fact conducted on staff assigned at MacLaren and that clean criminal records were obtained. Other exceptions include the Resource Utilization Management unit staff at MacLaren and some contractors, who do have access to children in the facility, but who did not undergo background checks.
• CL8 Page 211
  Investigations of allegations of abuse by staff against children at MacLaren are not adequately addressed. In addition to potentially causing great harm to children, this also could place the County at risk of lawsuits. The policies and procedures related to other “special incidents” at the facility are not well documented and updated to include relevant regulations from CDSS and other procedures important to the day-to-day management of this component of the operations. The backlog in DCFS investigations adversely impacts MacLaren operations from a number of perspectives, and must be addressed. MacLaren also needs to do a more effective job with its own internal staff investigations that are conducted by coworkers and have been characterized as perfunctory at best. Therefore, while DCFS needs to meet the legal obligation of child abuse investigations, MacLaren should still conduct its own rigorous internal investigation and take corrective action where appropriate. The best reporting relationship for an internal investigative position at MacLaren from an organizational perspective is a direct one to the Administrator. Should the findings of an investigation lead to recommendations of disciplinary actions against the employee, then some coordination between the personnel unit and the Administrator’s office will need to take place.
• CL9 Page 216
  The decentralized nature of the human resources function at MacLaren has resulted in numerous complications. Among these are: the inability of MacLaren management to control the type and level of staffing at the facility; various problems in the areas of Health Services, including high turnover and disagreements regarding reporting relationships and staffing decisions; inability to keep accurate item control, with the result being no one at the facility able to provide an accurate accounting of the number and types of staff assigned to MacLaren at any given time. These complications have lingered for years because, given the decentralized nature of the operations, no one has been held accountable for the its overall efficiency and effectiveness.
• CL10 Page 239
  Though its total costs are very high, MacLaren Children’s Center management functions without benefit of basic financial tracking information and systems. A consolidated budget does not exist nor are actual facility-wide expenditures reported to management to ensure accountability and to enable analyses of costs compared to outcomes. The Department of Children and Family Services (DCFS) has always treated MacLaren Children’s Center as a separate cost center so the budget and actual expenditures for the DCFS portion of MacLaren is readily available. Similarly, the school operated on site by the Los Angeles County Office of Education is a separate cost center for that organization and those costs and expenditures are readily available though not reported to the MacLaren Administrator or financial officer. Budgeted and actual expenditures incurred by the Departments of Mental Health and Health Services at MacLaren are not tracked or reported separately and MacLaren management does not routinely receive this information. Decisions and controls regarding staffing levels, procurement of fixed assets and overtime are decided by the parent agencies, not the MacLaren Administrator. Extraction and compilation of budgeted and actual expenditures for the primary agencies at MacLaren revealed that actual expenditures in FY 2000-01 was an estimated $37,713,970, or $728 per child per day. For FY 2001-02, projected costs per child per day will be $757 or $276,305 per year. With such high costs, it is critical that the MacLaren Administrator and management is informed on all expenditures and has the ability to control costs. In addition, MacLaren management should be responsible for ensuring that any new costs or services are reasonable relative to the services provided. Such systems are not in place at this time though the facility’s Operational Agreement delegates “direct authority and responsibility for all on site multiagency service delivery” to the Administrator. To have this level of authority without the benefit of cost information is a poor management practice. Potential opportunities exist to lower costs without worsening program outcomes through restructuring MacLaren’s management structure, consolidating and controlling procurement, and allocating staff and other resources based on outcomes rather than maintenance of the status quo. All of this requires consolidated financial information and reporting and authority and accountability delegated to the Administrator.
• CL11 Page 267
  The Department of Children and Family Services has developed relatively little data assessing the quality of investigations of child abuse and neglect, and whether children are inappropriately removed from their custodial parents. Even where data has been developed, no analysis has occurred. For example, the percentage of cases in which the Intake and Detention Control Unit is requested to prepare a petition for a child that has been detained, but declines to do so because of insufficient evidence, has fallen substantially since FY 1996-97, particularly in the past 2.5 years, but no review has been made as to why this occurred. However, an analysis conducted by audit staff of 67 cases where children were detained in October and November 2001 found no evidence that any of the detentions were improper, and showed that multiple collateral contacts occurred as part of the investigation in most cases.
• CL12 Page 287
  State law requires social workers investigating allegations of abuse and neglect to determine whether there are services available that could permit them to safely remain in their custodial parent’s or guardian’s home. Such “reasonable efforts” must also be documented in reports to the courts. However, a review of a sample of 67 DCFS case files found that documentation was not provided to the court in about 24 percent of the files. Even where documentation was provided, court reports had no detail about the services provided, despite recent training on the level of detail that should be provided. Furthermore, about 30 percent of the case files lacked evidence that clients were referred to services, regardless of the information provided to the court. A focus group of social workers found one source of these problems may be a lack of information by 311 Section 2: Documentation of Reasonable Efforts Emergency Response Command Post workers as to services available in various areas of the County.
• CL13 Page 289
  To assist social workers in assessing allegations of child abuse and neglect, the Department of Children and Family Services (DCFS) requires use of “assessment tools” to determine which Child Abuse Hotline referrals should receive in-person investigation, and how soon, and to determine the risk to children who are the subject of in-person investigations, to decide whether to remove a child from the custodial parent. However, a review of 68 case files, and interviews with social workers, found 322 Section 3: Use of Assessment Tools and Procedures these tools are not always used, or are used in a perfunctory manner. For example in only 42.6 percent of the cases examined was the Assessment Guide used by Emergency Response social workers properly completed. Furthermore, this tool does not reflect the most current research in the field. Also, while the Department’s procedures manual is extensive, there are gaps in some areas, and the manual is not formatted in a manner that would be easy for ER workers to refer to in the field. As a result, the Department is not assured that the goals of the assessment tools and procedures, which are to ensure consistency and accuracy in investigations, are met.
• CL14 Page 316
  Use of CWS/CMS by social workers to prepare and store key court documents in child abuse and neglect cases is inconsistent, based on a review of 66 cases, which found that in 15 cases, one or more key documents were not stored on the system. DCFS staff cited inconsistent access to the system, due to insufficient computer capacity at regional offices, inability to access CWS/CMS document formats in the field and the lack of a 327 Section 4: Use of CWS/CMS System by Social Workers policy requiring use of CWS/CMS as factors contributing to the inconsistent system use.

No Responses Found 3

Government entities assigned to respond to this report. No response documents have been linked in our database.