Santa Clara County Grand Jury
• 2007-2008
2007-2008 Santa Clara County Civil Grand Jury Report Failed Health Care Tracking Puts County Foster Children at Risk
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 8 findings
F1
DFCS has failed to deliver HEP binders to foster parent caregivers in 10% of child placements. This was found for both initial placements, and for subsequent changes of placement.
Related Recommendations (1)
R1
DFCS needs to determine the cause for failing to deliver HEP binders for all placements and take corrective action to eliminate this problem.
F2
DFCS has failed to meet the mandated time schedule for delivery of HEP binders to one-third of the foster parent caregivers. This was found for initial placements as well as for subsequent changes of placement.
Related Recommendations (1)
R2
DFCS needs to determine the cause for late delivery of HEP binders, and to take corrective action to ensure compliance with mandated requirements.
F3
Caregivers are generally aware of the correct forms to be used by medical providers for updating the child health information. However, there is a lack of knowledge of who should receive copies of these forms, and that the caregiver needs to put copies in the HEP binders.
Related Recommendations (1)
R3
DFCS should increase instruction in procedures and preparation of caregivers to ensure that caregivers are aware of their responsibility to maintain and update the HEP binder in their possession, and that the caregivers know the correct procedure for forwarding medical information back to DFCS. 9
F4
The comments sent in by the respondents contain a number of suggestions for improvements.
Related Recommendations (1)
R4
DFCS should review the comments with the caregivers, and evaluate them to determine if there are useful improvements that should be incorporated. Key
F5
After each medical or dental visit, to whom do you return the copy of the form so this information can become a part of the child’s official medical records? (Please check all that apply) Social Worker Public Health Nurse (CHDP) DFCS Other
Related Recommendations (1)
R5
After each medical or dental visit, to whom do you return the copy of the form so this information can become a part of the child’s official medical records? (Please check all that apply) Social Worker Public Health Nurse (CHDP) DFCS Other
F6
The DFCS requires that you receive a copy of the child’s medical records after each update of information. How often does this occur? Usually Sometimes Seldom 19
Related Recommendations (1)
R6
The DFCS requires that you receive a copy of the child’s medical records after each update of information. How often does this occur? Usually Sometimes Seldom 19
F7
Is DFCS responsive to your request for action or information regarding the health needs of the child (children)? Usually Sometimes Seldom
Related Recommendations (1)
R7
Is DFCS responsive to your request for action or information regarding the health needs of the child (children)? Usually Sometimes Seldom
F8
Do you have any recommendations to improve the procedures regarding updating medical records and ensuring that the caregiver has the most current medical information? (attach additional pages if necessary) Thank you for your time and effort in completing this questionnaire. Please return no later than Friday, April 11, 2008 in the enclosed self-addressed stamped envelope addressed to: Attention: Mr. Ray Blockie, Foreperson Santa Clara County Civil Grand Jury Superior Court Building 191 North First Street San Jose, CA 95113 20 APPENDIX D Caregiver Category Definitions Shelter: A facility where children are brought if no placement is located. Court-Specified Home: A home where children are placed under court direction. Foster Family Agency Home: A home that is certified through a private agency to provide foster care services. Foster Family Home: A home that is licensed through Santa Clara County to provide foster care services. Group Home: Group homes provide the most restrictive out-of-home placement option for children in foster care Guardian Home: A home where the caregiver decides to become the legal guardian of a foster child. Relative/Non-Relative Extended Family Member: Relative caregivers are blood related and non-related caregivers have a bond with the child (godparents, a significant adult in the child's life, etc.) Small Family Home: A home that is licensed through Community Care Licensing to provide specialized foster care services 21 APPENDIX E Summary of Questionnaire Comments Positive Comments “Our foster daughter's Public Health Nurse, is wonderful! She is very responsive, helpful and supportive! When I questioned the accuracy of our Foster Daughter’s Immunization record, she accessed the CAIR website (California Immunization Record) and found an error. She explained that many people input data into foster children's HEP binders and mistakes can occur. I don't have any recommendations on how to ensure the accuracy of each HEP binder, but for future placements, I plan to ask the Public Health Nurse to compare the child's immunization record in the HEP binder to the CAIR database.” “I am happy w/ California's newest social worker.” “Very satisfied” “I think the system is working fine.” “The system was good, not great but good.” “I was impressed with the binder and forms that were given to me because it was a very organized and comprehensive system (I thought).” “Great Job!” “My last social worker has been up to date by getting the information I needed for the Foster child that is here in my home.” “We have been very satisfied with the information we have received” “In time I had foster children in my home HEP booklet came after child place back to parent into another country. The HEP booklet is very helpful when you don't know children allergy or what.” “The first time I had my granddaughter … I had help from …. She is a relative support team member. When things didn't happen fast enough she persisted and got results. She is a dedicated worker. … is a very dedicated social worker. She has and is doing everything to help my granddaughter.” “I am satisfied with the procedures regarding updating medical records. Do not have any
Related Recommendations (1)
R8
Do you have any recommendations to improve the procedures regarding updating medical records and ensuring that the caregiver has the most current medical information? (attach additional pages if necessary) Thank you for your time and effort in completing this questionnaire. Please return no later than Friday, April 11, 2008 in the enclosed self-addressed stamped envelope addressed to: Attention: Mr. Ray Blockie, Foreperson Santa Clara County Civil Grand Jury Superior Court Building 191 North First Street San Jose, CA 95113 20
Conclusions 12
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CL1 Page 9DFCS has failed to deliver HEP binders to foster parent caregivers in 10% of child placements. This was found for both initial placements, and for subsequent changes of placement.
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CL2 Page 9DFCS has failed to meet the mandated time schedule for delivery of HEP binders to one-third of the foster parent caregivers. This was found for initial placements as well as for subsequent changes of placement.
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CL3 Page 9Caregivers are generally aware of the correct forms to be used by medical providers for updating the child health information. However, there is a lack of knowledge of who should receive copies of these forms, and that the caregiver needs to put copies in the HEP binders.
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CL4 Page 10The comments sent in by the respondents contain a number of suggestions for improvements.
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CL5 Page 17During the calendar years 2006 and 2007, how many children were placed with you? 2006 2007 Please answer Questions 2 and 3 for each child in your placement.
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CL6 Page 17The Department of Family and Children’s Services is required to send to the caregiver a Health and Education Passport binder (HEP binder) within 30 days of the child’s first placement. The binder includes health and educational information on the child from birth to the present. If you provided care during a child’s first placement in the system: a.) For which children did you receive the HEP binder within 30 days? Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 List any additional children. b.) For which children did you receive the HEP binder after 30 days? Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 List any additional children. 17 c.) For which children did you NOT receive the HEP binder? Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 List any additional children.
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CL7 Page 18If you provided care for the child after the first placement ended, the HEP binder should have been passed on to you within 48 hours of the child being placed in your care, as required by the Department of Family and Children’s Services. a.) For which children did you receive the HEP binder within 48 hours? Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 List any additional children. b.) For which children did you receive the HEP binder after 48 hours? Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 List any additional children. c.) For which children did you NOT receive the HEP binder? Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 List any additional children. 18
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CL8 Page 19What medical forms or information do you take to appointments for the medical care provider to review, update or fill out?
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CL9 Page 19After each medical or dental visit, to whom do you return the copy of the form so this information can become a part of the child’s official medical records? (Please check all that apply) Social Worker Public Health Nurse (CHDP) DFCS Other
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CL10 Page 19The DFCS requires that you receive a copy of the child’s medical records after each update of information. How often does this occur? Usually Sometimes Seldom 19
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CL11 Page 20Is DFCS responsive to your request for action or information regarding the health needs of the child (children)? Usually Sometimes Seldom
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CL12 Page 20Do you have any recommendations to improve the procedures regarding updating medical records and ensuring that the caregiver has the most current medical information? (attach additional pages if necessary) Thank you for your time and effort in completing this questionnaire. Please return no later than Friday, April 11, 2008 in the enclosed self-addressed stamped envelope addressed to: Attention: Mr. Ray Blockie, Foreperson Santa Clara County Civil Grand Jury Superior Court Building 191 North First Street San Jose, CA 95113 20 APPENDIX D Caregiver Category Definitions Shelter: A facility where children are brought if no placement is located. Court-Specified Home: A home where children are placed under court direction. Foster Family Agency Home: A home that is certified through a private agency to provide foster care services. Foster Family Home: A home that is licensed through Santa Clara County to provide foster care services. Group Home: Group homes provide the most restrictive out-of-home placement option for children in foster care Guardian Home: A home where the caregiver decides to become the legal guardian of a foster child. Relative/Non-Relative Extended Family Member: Relative caregivers are blood related and non-related caregivers have a bond with the child (godparents, a significant adult in the child's life, etc.) Small Family Home: A home that is licensed through Community Care Licensing to provide specialized foster care services 21 APPENDIX E Summary of Questionnaire Comments Positive Comments “Our foster daughter's Public Health Nurse, is wonderful! She is very responsive, helpful and supportive! When I questioned the accuracy of our Foster Daughter’s Immunization record, she accessed the CAIR website (California Immunization Record) and found an error. She explained that many people input data into foster children's HEP binders and mistakes can occur. I don't have any recommendations on how to ensure the accuracy of each HEP binder, but for future placements, I plan to ask the Public Health Nurse to compare the child's immunization record in the HEP binder to the CAIR database.” “I am happy w/ California's newest social worker.” “Very satisfied” “I think the system is working fine.” “The system was good, not great but good.” “I was impressed with the binder and forms that were given to me because it was a very organized and comprehensive system (I thought).” “Great Job!” “My last social worker has been up to date by getting the information I needed for the Foster child that is here in my home.” “We have been very satisfied with the information we have received” “In time I had foster children in my home HEP booklet came after child place back to parent into another country. The HEP booklet is very helpful when you don't know children allergy or what.” “The first time I had my granddaughter … I had help from …. She is a relative support team member. When things didn't happen fast enough she persisted and got results. She is a dedicated worker. … is a very dedicated social worker. She has and is doing everything to help my granddaughter.” “I am satisfied with the procedures regarding updating medical records. Do not have any
Comments 20
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CO1 Page 6“They have always been helpful to me.”
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CO2“It’s working very well for me.” 6 Some of the respondents indicated satisfaction with HEP binders and considered them useful:
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CO3 Page 7“The HEP booklet is very helpful…”
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CO4 Page 7“I was impressed with the binder and forms that were given to me because it was very organized and comprehensive system…”
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CO5 Page 7“The HEP binder is … very helpful.” Negative comments were more numerous, 43 negative versus the 21 positive. A common complaint was the need to get complete medical data as soon as possible:
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CO6 Page 7“Give us the medical information we need.”
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CO7 Page 7“Just give us complete medical problem info of the child as soon as you give the passport binder to us. Cause most of the time is incomplete.”
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CO8 Page 7“The children come from the shelter with the wrong info.”
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CO9 Page 7“…we do not get any (or) very little limited information on the child.”
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CO10 Page 7“Information is very scant…” Another common thread is the lack of communication between the caregivers, medical providers, and DFCS/PHN:
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CO11 Page 7“…doctors look at me as though I have 2 heads when I ask them to fill out forms.”
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CO12 Page 7“Did not know there were forms to fill out and give to someone.”
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CO13 Page 7“…didn’t know where to send update medical records.”
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CO14 Page 7“Medi-Cal cards don’t work all the time…” Nine suggestions were generally along the line of improving communication and providing medical data in a timelier manner:
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CO15 Page 7“Offer classes for foster parents and SW’ers to review procedures.”
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CO16 Page 7“The doctor’s office should send copies of the medical records to social worker instead of foster parent.”
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CO17 Page 7“Make phone numbers for previous health care provider known…” 7 A specific suggestion that was common was to incorporate some online access to simplify the procedures:
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CO18 Page 8“Forms available online would have been a wonderful tool.
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CO19 Page 8“…online access & printing capacity…”
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CO20 Page 8“…set up an online system…” The comments and suggestions reinforced the understanding that the system is about real children with real needs being cared for by people who have a genuine interest in the child’s welfare and well-being. In this context, any shortcomings are unacceptable.