There is no Margin of Error: A C l A h t Child lfA Calm...
Transcript of There is no Margin of Error: A C l A h t Child lfA Calm...
There is no Margin of Error:A C l A h t Child lfA Calm Approach to Child welfare
Center Hosted WebcastCultural Change SessionCultural Change Session
Friday May 16, 2008Alan Abramowitz and Ron Zychowski
OBJECTIVESOBJECTIVES• System challenge • Identify Fixy g
– Panic impact – Unintended Results
y– Remove Bias– Educate to options
• Community ReviewThreatened harm
– Do No Harm– Leadership
– Threatened harm– Investigator
observations• State Policy
– Safe Family – Passion and Bias– Conflict necessary
Longitudinal Studies
yPreservation
– Task Force on Child Welfare– Longitudinal Studies Welfare
THE PROBLEM IN CHILD WELFARETHE PROBLEM IN CHILD WELFARE
• Mistakes happen35.335
40
Florida
• Fix is total focus– It will be fixed, but…
20
25
30California
Illinois
New York
Ohio
– Unintended results• Inefficient 8.8
10
15
20 Ohio
• Ineffective 0
5
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Years
• Palm Beach child deaths over past 15Palm Beach child deaths over past 15 years and spikes from Kathleen Chapman articlearticle
The “deck is stacked” against theagainst the
“best interest of the child”
• Question: Why does Quality Assurance support virtually every removal?support virtually every removal?– Discussion– Quality Assurance challenge– Solution
• Question: Why historically have investigators been asked to resign when a child is hurt that gwas not removed?– Discussion– Why this decision is adverse to childreny– Solution
DO NO HARMDO NO HARM
Hippocratic Oath – Excerpt Classical Version
“… I will apply dietetic f h b fimeasures for the benefit
of the sick according to my ability and judgment;my ability and judgment; I will keep them from harm injustice ”harm injustice…
PROTECTING A CHILD
A professional judgment based on all the facts and determining services which willfacts and determining services which will mitigate risk, if possible.
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The Math of Passion Max Weber (1864-1920)
• Social Workers have passion
• Passion + Bias =
• Passion – Bias =
• Bias can be increased or decreased
1995 U.S. OpenC fid LConfidence Lost
Agassi compiled a career-best 26-match winning streak, which ended when he lost in a hugely anticipated U.S. Open final to SamprasSampras.
Andrea Agassi had just attained been #1 in world
Foster Care panic!Foster Care panic!
Drastic change in child removalDrastic change in child removal called a foster care “spike”
C fli t di dConflict discouraged
Negative impact of spike on systemNegative impact of spike on system of care
N ti i t hild ltiNegative impact on children resulting from spike
Community develop plan
TEAM FINDINGTEAM FINDING• Remove bias
Conflict has positive effect– Conflict has positive effect– Leadership needed– Team ApproachTeam Approach
• Remove fear – Support staff– Understand harm of removal– Decision on right level in org chart
• Shelter rate– Spike at all levels of organization
Spikes harm children– Spikes harm children
• Food Stamps, CashFood Stamps, Cash Assistance and Medicaid
• Poverty is the number one• Poverty is the number one indicator of abuse or neglectStress impact• Stress impact
• Partner collaboration – Look at quality of life
TOGETHER WE REMOVE BIASAn Approach which removed bias in the 5th Circuit
Circuit 5 Children Served
5000
4000
4500
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3500 Children
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Jun-0
5Sep
-05Dec
-05Mar-
06Ju
n-06
Sep-06
Dec-06
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Source
Who: J. JohnsonWhat: HSn ReportWhen: 06/14/07
J S D M J S D M
2007 MIT Study2007 MIT Study
15,000 children / No high risk cases ConclusionsConclusions
1. Arrested at least once1. Stayed with family: 14%2 W t t f t 44%2. Went to foster care: 44%
2. Became teen moms1. Stayed with family: 33%2. Went to foster care: 56%
3. Held a job 3 months1. Stayed with family: 33%y y %2. Went to foster care: 20%
2006 Minnesota Studyy“The Impact of Foster Care on Development”
• Kincare better outcomes than foster care– 189 children longitudinal study
Si il lt t t f f t d l ti– Similar maltreatments for foster care and relative care (in home, out of home, and control group)
• “Children placed into unfamiliar foster careChildren placed into unfamiliar foster care showed ‘higher levels of internalizing of problems compared with children reared by maltreating caregivers children in familia caremaltreating caregivers, children in familia care, and children who receive adequate care giving.”
Chapin Hall / Jim Casey:Chapin Hall / Jim Casey:• Chapin Hall: The 500,000 children in foster care p ,
are more likely than other kids to drop out of school, commit crimes, abuse drugs and become teen parentsbecome teen parents.
• Jim Casey: Confirms kids who can remain in• Jim Casey: Confirms kids who can remain in their homes do better than in foster care… Some kids, for their own safety, need to be removed from their families, but in marginal cases of abuse, more should be done to keep them togethertogether.
Children in Out of Home Care P f P th th i P i S h lPerform Poorer than their Peers in School• Score substantially lower than other youthScore substantially lower than other youth
on the FCAT• Twice as likely to be held back a greatTwice as likely to be held back a great• Two and Half time more likely diagnosed
with a “less severe” learning disabilitywith a less severe learning disability• Seven times more likely to be diagnosed
with a “severe” disability.with a severe disability.• Twice as likely to have disciplinary
problemsproblems
FORMER FOSTER YOUTHLIKELY TO ACHIEVE SELF SUFFICIENCY AS O C S SU C C S
ADULTS• Were employed at same rate, but earnedWere employed at same rate, but earned
¼ th the median wage for their age group.• Four times more likely to receive foodFour times more likely to receive food
stamps and nine times more likely to receive Temporary Assistance to Needy p y yFamilies.
• 17 times more likely to be homelessy• Three times more likely to be in prison or
probation.p
FLORIDA POLICYFoster Care Waiver returns Florida to
Safe Family PreservationSafe Family Preservation:
Enables funds to be used for– Enables funds to be used for … prevention, intensive in-home services to prevent placement of children outside p pthe home, reunification and foster care….
– Funding incentives in line with the goals of providing services that help familiesof providing services that help families remain intact whenever possible.
FLORIDA POLICY –General Butterworths Task Force on Child Welfare
Recommendations: theRecommendations: … the Department and Community Based Care Lead AgenciesBased Care Lead Agencies explore the promise of the IV-E waiver implemented in Octoberwaiver implemented in October 2006 and the opportunity to use available funds to preventavailable funds to prevent removal by providing intensive and effective home servicesand effective home services.
Other Culture Changes NeededOther Culture Changes Needed
• Communication• Communication– Continuous Community information sharing is critical– Sharing good news with protective investigators on cases will remove bias
• Quality Assurance (oversight)J d t l t C iti l thi ki– Judgmental to Critical thinking
– Goal of Improvement not judgment– Need to recognize that CBC is impacted by cbc (lower case letters)– Must not shift to “best practices” instead of “best interest”
Di i li A ti• Disciplinary Action– Look at career as well, not just the case– Are children better served with employee on team or with a new employee– Decision should be understood by staff and must be transparent with staff
• Tracking Front Door– Understand removals impact on CBC outcomes – Clearest way to determine if CBC will succeed or fail
• Measure success in a “child first” waiver world– Must plan savings to front end prevention– If abuse / neglect occurs community already failed
“ There is no margin of“… There is no margin of error when working witherror when working with children. No one is allowedchildren. No one is allowed a bad day…”y
-- Secretary Bob Butterworth, Statewide Dependency Summit 2007