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Extracted from Consolidated Report

This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.

Los Angeles County Grand Jury • 2011-2012

Child Death Mitigation in Los Angeles County

40 pages
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Findings 5 findings

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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
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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.
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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.
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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
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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.

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