Progress of CFSP Plan for FY 2005-2009
In August 28, 2003, Governor Bob Holden issued an executive order reorganizing the Department of Social Services which created a Children's Division by combining the Children Services Section of the former Division of Family Services with the Office of Early Childhood. The goal for establishing the new division was to improve the effectiveness and efficiency of the child welfare system by heightening the focus on children's issues within the agency and leveraging prevention investments to reduce abuse and neglect. The new organizational structure emphasized front line staff support with renewed committed leadership to the continuous quality improvement movement which builds on existing strengths. Just prior to the re-structure, the Children's Services underwent an extensive review of organizational needs and focused the reorganizing efforts on practice excellence. These needs included:
- A clearly articulated vision and mission
- An organizational structure aligning with judicial circuits with support through cross-functional teams at the state, regional and local levels
- Strong partnerships with communities, courts, law enforcements and treatment providers
- High quality training for all staff
- Mentoring program for new staff
- Flexible funding to meet the unique needs of children and families
Approximately ninety days following the roll out reorganizing structure, the federal Child and Family Services Review (CFSR) on-site case review occurred. Both the reorganizing efforts and CFSR outcomes impacted the development of our last five year plan. In the five year plan, there were four overarching themes. Each theme had specific goals aimed at improving services for the children and families we serve. The themes and goals were as follows:
- Organizational Re-structure
- Establish Circuit Based Leadership
- Form Practice Enhancement Teams / Technical Assistance
- Construct a QI/QA structure for constant evaluation of performance with improvement efforts
- Creating true partnerships between the public and private sectors
- Use flexible funding to meet the needs of children and families
- Generate Circuit Based Assessments
- Craft Circuit Based Program Improvement Plan
- Reduce Caseload Sizes
- Implementation of Performance Based Contracting
- Achieve Accreditation
- Develop Ongoing Professional Development
- Design Competency Based Supervision Training
- Design Competency Based Basic Training
- Develop ongoing training for staff
- Design on-the-job training to assist workers in mastering performance skills and increased professionalism
- Create Web Based Training
- Interactive online modules and courses
- Increase staff skill levels and education
- Practice Enhancements
- Increase Supervisor's Support
- Produce improvements towards CFSR data indicator goals
- Develop a SACWIS compliant management system with real time information
- Development of ongoing key early intervention strategies in service delivery
- Ongoing evaluation of safety tools
- Reduce children re-entering care
- Increase stability of foster care children with a special emphasis on early identification of family dynamics to expedite the provision of effective services
- Organizational Re-structure
Establishment of Circuit Structure
One of the earliest re-structuring events established circuit geographical partitions. These circuit geographical partitions mirrored the judicial divisions as set forth in Article V of the Missouri Constitution whereby, a circuit court has jurisdiction over all cases and matters, civil and criminal and is divided into convenient circuits of contiguous counties. By following this same grouping and establishing a circuit manager position, familiarity with local court procedures increased which enhanced court relationships. This structure's purpose was to foster trust and increase communication with our courts personnel, in turn, our service delivery would benefit.
The organizational structure not only changed geographically but also internally. Both processes focused on responsiveness and support to our consumers and our employees. Recognizing we have extremely dedicated employees, the new design sought to honor and respect our employees by increasing skilled personnel, improving communication, strengthening supervisory support and bolstering our quality assurance and quality improvement activities.
Practice Enhancement Teams / Technical Assistance
The Children's Division has created a model for solving identified issues. The model consists of two paths, one requires the forming of a workgroup, and the other requests in-the-field technical assistance and support from the Central Office Staff.
The workgroup model may be useful on the micro, mezzo and macro levels. The group participants are chosen according to their expertise in the subject matter by an administrator. The group assesses and evaluates all information surrounding the issue and in a solution focused fashion prepares recommendations for consideration. This model has proven very successful for some types of issues. For example, workgroups have been used on the macro level to study how to measure success in preparing youth for adulthood for the foster care case management contracts. Through their recommendations, the contractors are capturing the success measures and these are to be considered when developing the next foster care case management contracts.
Technical Assistance / Field Support
In order for Central Office to provide solution focused technical assistance, a request must originate from the field with a clear written statement describing the request, information on the actions already taken and a desired outcome. The request must be presented through normal supervisory channels to the Practice and Professional Development Unit Managers for assigning appropriate staff. This model was put into practice in mid-2007. In 2007, 6 requests were made; in 2008, 9 requests were made and 6 requests have been received to date in 2009. Most requests are for specific individualized training and reviewing cases for an identified purpose.
Construct Enhanced QA/QI Structure
After the first round of the on-site CFSR review, the Quality Assurance (QA) program was restructured. In March 2005, the new Quality Assurance unit was formed. Composed of a Unit Manager and seven regionally based Quality Assurance Specialists, the unit was designed to meet circuit, regional and statewide quality assurance needs. Each QA Specialist received extensive training in data analysis and computer software training (MS Excel). The QA Specialists monitor outcome measurements on a regular basis to determine service delivery and program effectiveness. These outcome measurements provide real and useful information which alleviate the need to rely on assumptions. In addition, QA Specialists monitor the case review information and assist staff in identifying trends and weaknesses. Measuring, monitoring and improving the quality of service provision are central to ensuring positive outcomes for children and families served by the division. Three additional staff have since joined the QA Unit, including a Management Analysis Specialist responsible for CFSR Coordination, and two Program Development Specialists, who provide support and oversight for QA activities.
Quality Improvement (QI) is a team process for achieving desired organizational results. In June 2007, the QI Unit was formed, and seven regionally based QI specialists were hired to assist circuit managers, supervisors and workers in planning and implementing change through various methods including: assisting in COA preparedness, readiness and sustainability for sites already reviewed; specialized training, case reading, situational modeling and employee shadowing. By employing a QI process which is founded on a good solid QA framework for data collection and monitoring, the Children's Division has improved its efforts to provide high quality and sustainable child welfare services.
The QA and QI specialists are co-supervised by Regional Directors and a respective QA or QI Central Office Unit Manager. QA and QI staff work together to identify gaps between desired and actual performance, identify root causes for poor performance and strategize to close the gap in service delivery. This partnership between QA and QI is a key step towards achieving best practice. Many QA and QI structured activities are in place to assure practice effectiveness and the achievement of desired outcomes.
See the Quality Assurance and Accreditation sections for specific additional information on QA and QI activities.
Public-Private Partnership/Case Management Contract
Missouri's performance based contracting is built on a public-private partnership with accredited agencies. Missouri believes child welfare is a complex arena and remains open to innovative approaches for case managing foster care children. Open communication with contracted providers is a critical component of Missouri's privatization effort. This was evident throughout contract development and continues to date through meetings which occur on a regular basis at the local, regional, and state levels.
In January, 2003, the contracted case management providers and state agency administrators were invited to participate in a discussion of a performance based case management contract. A meeting was held on 2/11/03. Plans to develop a performance based contract by 7/1/04 were diverted when Dominic James died at the hands of his foster father. Public and legislative outcry for child welfare reform ensued which included the development of contracts for comprehensive service delivery for children and their families by 7/1/05 in consultation with the community and providers of service. This led to regional meetings across Missouri in 2003 and statewide meetings of approximately 80 community stakeholders. The invitation list included current and potential contracted case management agencies and Intensive In-Home Services and Family Reunification Service contractors. In addition, each region sent invitations to community members such as child advocates, court personnel, legislators, and internal CD staff.
At the statewide meetings information was provided from the three workgroups which were formed to develop portions of the Request for Proposal (RFP). The workgroups discussed the enrollment process, outcomes, and provider qualifications. Information was also distributed, in writing, to allow the 80 stakeholders statewide an opportunity to provide input on these portions of the RFP.
Within the first six months of implementation of the performance based contracts Continuous Quality Improvement (CQI) Meetings were implemented at the local and regional levels. These meetings were designed to address implementation issues at the most local level possible. Issues which could not be resolved at the local level were referred to the regional CQI. Issues which could not be resolved at the regional level were referred to the CEO meetings.
As Missouri is now in the 4th year of a performance based case management contract, time is set aside at the CQI meetings for quality assurance/best practice discussions. As such, invitations for the regional CQI meetings are sent to the public and private QA and QI specialists.
Program Manager Meetings are held quarterly. These meetings now serve as the state level tier for the CQI process. This meeting is facilitated by a contractor. These meetings provide a forum to work on unresolved issues from the regional CQI meetings and an opportunity to share best practice. At the most recent meeting participants were put in small groups for discussion of strategies to develop permanent placements for older youth.
CEO meetings are also held on a quarterly basis. Recent items of discussion have included expenditure reporting, background screenings, outcome measures, court collaboration, SACWIS compliance, and joint QA/QI initiatives.
Joint Quality Assurance/Quality Improvement initiatives at the regional level include circuit CFSR Readiness Assessments, Program Improvement Plans to address deficiencies identified through the circuit self assessments, and Peer Record Reviews. Contracted staff, including their QA Specialists, are invited to attend the local CFSR/PIP meetings. The desired outcome is the development of joint QA/QI plans to address areas of concern and sharing of best practice.
Joint QA initiatives at the state level include federal reviews such as worker visits with children, Child and Family Service Review and AFCARS/data integrity. Contracted QA staff will be invited to attend CD QA Unit meetings twice per year. The contracted QA specialists are now routinely engaged in data clean up efforts to achieve improved data integrity.
On February 10th and 11th, 2009 Children's Division and contracted QA staff attended a two day training sponsored by Kids Hope United. This provided an opportunity for private and public staff to collaborate, share ideas for quality assurance and best practice, and share tools.
The PIP Advisory Committee, which was originally formed to monitor progress and develop strategies to improve areas of deficiency identified in the first CFSR, is comprised of CD staff and contracted agency representatives. This Committee continues to meet on a quarterly basis to prepare for the second CFSR.
The Children's Division is in the process of seeking accreditation by the Council on Accreditation (COA). According to Section 210.113 RSMo (HB1453, 2004), it is the intent and goal of the General Assembly to have the Department (Children's Division) attain accreditation by COA within five years of the effective date of this section (i.e. by August 28, 2009). To achieve accreditation, Missouri's child welfare system is reviewed and measured against over 800 nationally-recognized standards of best practice established by COA.
While all circuits simultaneously aim to meet standards of best practice, accreditation will be achieved circuit by circuit, from FY06 through FY09, until Missouri's child welfare system, as a whole, is deemed to be an accredited agency.
Circuit Based Assessments
In June 2004, each of Missouri's 45 judicial circuits was required to complete a self assessment evaluating its ability to meet standards established by COA. Each circuit was required to assess the suitability of its facilities, staffing needs, educational levels of staff, quality improvement processes, and the quality of case record documentation, practice, and outcomes. Strengths and weaknesses within each circuit, identified through the self-assessment process, provided information to position the circuits into the years in which they would best be prepared to undergo the scrutiny that accompanies the COA on-site review. This exercise also helped determine how to appropriately allocate resources based on the needs of each circuit. Following the completion of the circuit assessments, the Children's Division began its five-year plan to attain accreditation.
Self Study and COA Site Visits (Program Improvement Plans)
Throughout 2005, work teams were formed in Central Office to begin an in-depth review of standards with which COA requires compliance to achieve accreditation. Teams reviewed the standards, took inventory of how the agency already complied with the standards, noted areas of needs, and developed strategies to fulfill deficiencies in meeting all standards applicable to Central Office and to the agency as a whole. Documentary evidence (i.e. the agency Self Study) was compiled and submitted to COA, per COA guidelines, to demonstrate that the agency was in compliance with the standards (prior to the first on-site review in March, 2006).
The process that was rolled out to Central Office staff was replicated in the circuits selected to become accredited in the first, second, third, and fourth waves. Staff from the Quality Improvement (QI) and Quality Assurance (QA) Units provided training and ongoing technical support to staff in all circuits to assist them in preparing for their COA Site Visits. Additionally, to help prepare for the COA Site Visits, mock reviews, facilitated by QI and QA Specialists, were conducted in all accreditation sites after which there were planning meetings to determine how the agency and each circuit would ensure practice compliance with the standards.
Reduction of Caseload Sizes
Standardized, manageable caseload sizes required by COA standards allow workers adequate time to ensure they are providing consistent and quality services to children and families.
Funding must be in place for staffing in order to keep caseload sizes and supervisory/worker ratios within COA standards. The Division has been able to maintain 100% staffing in all sites that have been reviewed by COA thus far.
The Division's pairing of accreditation with the privatization of foster care has helped reduce caseload sizes without relying solely on the need for additional state staff. The contractor's ability to increase their caseload sizes has allowed state staff to remain within COA caseload requirements. This has also allowed the state's private contractors to champion the public/private partnership and lobby for accreditation in ways that the state agency is not able to do.
Implementation of Performance Based Contracts
Privatization of foster care case management moved from a fee for service model to a performance based contract for case management services which altered the payment structure considerably. Each contractor receives the base caseload which they were awarded. The base caseload and the percentage of children which are expected to move to permanency in 12 months are used to calculate the total number of additional referrals the consortium will receive throughout the contract year. The contractor is only paid for the base caseload. If they fail to meet the permanency expectation they will serve more children than what they are paid for. If they exceed the permanency expectation they will serve less than what they are paid for.
Achieving and Maintaining Accreditation
Four circuits (11, 32, 33, and 34) along with Central Office and the Child Abuse Hotline were selected to receive COA Site Visits in the first wave during State Fiscal Year (SFY) 2006.
Ten additional circuits (4, 6, 8, 18, 19, 21, 23, 29, 35, and 44) received Site Visits in the second wave in SFY 07.
Sixteen circuits (5, 7, 10, 12, 14, 15, 16, 17, 24, 25, 26, 28, 31, 36, 40, and 43) were reviewed in the third wave in SFY 08.
COA has deemed all circuits reviewed in the first, second, and third waves to be in compliance with accreditation standards.
The final fifteen circuits (1, 2, 3, 9, 13, 20, 22, 27, 30, 37, 38, 39, 41, 42, and 45) are being reviewed in SFY 09 (the fourth and final wave). To date, as of May 27, 2009, fourteen of the fifteen Site Visits have been completed, and eleven of the fifteen circuits have been approved by COA. Three additional circuits are awaiting compliance notifications from COA. The final Site Visit is scheduled to occur in St. Louis City (Circuit 22) the week of June 15, 2009.
Immediately following approval by COA, QI Specialists have been leading the effort to monitor all circuits that have been deemed in compliance with accreditation standards through quarterly maintenance visits. Maintenance activities include periodic reviews of case records and personnel files to ensure that the content and quality of documentation remain in compliance with accreditation standards. The Children's Division will be subject to re-accreditation reviews every four years to retain its accreditation status.
The Division is systematically achieving its statewide goal and objectives. Staff, community partners, and the children and families of Missouri will greatly benefit from this accomplishment.
During the past five years the Professional Development and Training Unit has met several benchmarks by developing and improving existing competency based training programs for supervisory and frontline staff which assists them in their professional development. The agency has been able to achieve ongoing professional development for all staff in making the following improvements:
Developing Ongoing Professional Development
The professional development of staff is considered to be a 'system' within the agency and relies upon key elements to work together. These elements include classroom training, on the job training and reinforcement of skills in the field between staff and the first line supervisor.
New workers participating in Child Welfare Practice Training participate in On the Job training activities which assist in their professional development. Their skill areas are assessed by using a self evaluation tool of competencies along with Two-Way Feedback Tools and Skill Development Plans. On the Job training activities are also provided during the core in-service training modules and Clinical Supervision Training.
Professional development opportunities are provided to staff through department and division training opportunities. The CD also partners with the University of MO educational system to provide opportunities for staff to participate in MSW programs.
On-going professional development of staff is supported and encouraged by the Children's Division and the department. In 2007 the state of Missouri implemented the Productivity, Excellence and Results for Missouri (PERforM) system to facilitate the development of annual performance objectives and the electronic storage and reporting of employee performance appraisal records.
The PERforM system serves as an online "tool" to assist supervisors, managers and state agencies with the most fundamental of human resource management responsibilities: planning specific, measurable work objectives, and the observation, evaluation and development of each employee's performance.
A key piece of this process is for supervisory staff to work with their employees on the development of the Employee Development Plans. The goal of the EDP is to promote continuous learning for the employee, to prepare the employee for new challenges and opportunities, and to meet current and future organizational needs. The EDP can assist the supervisor and employee in documenting, monitoring and achieving the employee's professional development goals. Goals can be reached by attending trainings, workshops or seminars; working with a mentor or other means identified by the employee and supervisor.
Design Competency Based Supervisory Training
In the past frontline supervisors had been required to attend Basic Orientation for Supervisors (BOS) with content focused on management issues. Prior to 2001 BOS training had been placed on hold due to budget constraints. In 2001 the Children's Division began working on a competency based clinical supervision training for frontline supervisors. As a workgroup from the training unit began to work on research and development of this curriculum an opportunity to participate in a grant from the Children's Bureau surfaced. In 2002, the CD along with the University of Missouri-Columbia and Prevent Child Abuse Missouri applied for and was awarded a 3 year grant to provide training to frontline supervisors. This research based project became known as the Role Demonstration Project. Supervisors from 2 different sites in the state participated in quarterly competency based training. At the conclusion of this grant in 2005, the Children's Division began finalizing a 39 hour competency based clinical supervision training for front line supervisors based upon lessons learned during the Role Demonstration Project. This curriculum was completed and implemented in 2006. All CD frontline supervisors were provided the training and this training continues to be offered on a regular basis for newly hired supervisors.
The newly developed Clinical Supervision training is a two part curriculum. Supervisors are expected to complete on-the-job training assignments prior to part one, between parts one and two and following part two. Classroom content includes: Supervisor expectations; Characteristics and Change in Roles; the Supervisors Role in CWPT (Child Welfare Practice Training); Time Management; Supervision Styles; Strengths Based-Solution Focused Techniques to Use with Families and Staff; Case Consultation; Assessing for Safety and Risk of Children during Case Consultation; Stages of Crisis Intervention; Critical Decision Making; Compassion Fatigue; Coping Strategies; Ethics in Childe Welfare Practice; Professional Development and EPPA's; Use of Group Supervision; Group Process; and Leadership.
In 2007 a 12 hour Critical Thinking Skills Training for supervisors was added to the training curriculums to be completed by the frontline supervisors. Supervisors are also offered a 6 hour in-service course by program area (CA/N, FCS and FCOOHC).
The current structure of training for frontline supervisors is the initial completion of the 40 hour Basic Orientation for Supervisors (BOS) offered by the department; 39 hours of Clinical Supervision Training and 12 hours of Critical Thinking Skills Training. After this is completed in the first year of employment each supervisor is required to obtain 16 hours of in-service training per year to meet the Management Training Rule requirements.
Design Competency Based Basic Training
Historically, new Children's Services workers have been required to attend Child Welfare Practice Basic Orientation Training. This initial training for staff takes place in their first few months of employment and consists of 126 hours of classroom training conducted by agency staff trainers along with on-the-job training conducted at the local office level.
This curriculum is reviewed on a regular basis to ensure it is meeting best practice, policy requirements, federal and state mandates and COA standards. The most recent major revision began prior to 2005 with workgroups from the training unit. Focus groups and field test groups were used for input and feedback from field staff to help ensure the curriculum would meet the needs of new employees. This revision was finalized and implemented statewide in 2006. The result of this work was a competency based curriculum with a focus on trainer modeling and skills practice for the participants. The core competencies are interwoven throughout the content of the curriculum.
This course begins with each participant completing an individual self-assessment of each of the competency areas. The goal is for the classroom training to provide observation experiences, activities, and skill practices while On-the-Job training will include shadowing experiences, supervisory conferences, and on-going worker development activities to assist the employee in the development and growth in each identified competency area. The participant completes a post-assessment of the competencies at the conclusion of the classroom training. Both the pre- and post-assessments are to be shared with the trainer and the supervisor in order for the employee to identify areas for skill development, prioritize those areas, and then identify ways to build those skills. The tool may also be useful as a starting place for discussion and feedback about the supervisor's perspective on the worker's strengths and needs.
Content of this training over the course of 5 classroom sessions includes: Family Centered Philosophy and Skills Training; Child Abuse/ Neglect Investigations/Family Assessments/ Application of Family Centered Philosophy and Skills for Intact Families; Expedited Permanency and the Family Centered Out of Home Care Process; Children's Division Computer Systems Training; and Reinforcement and Evaluation.
Develop Ongoing Training for All Staff
In conjunction with the Department of Social Services an ongoing training structure of in-service trainings has been developed for all staff.
All staff are provided the following training opportunities:
- Code of Ethics/CQI Training within 60 days of employment and annually thereafter. (On-line course)
- Personnel Health & Safety Training within 3 months of employment and annually thereafter. (On-line course)
Frontline supervisors are provided the following training opportunities:
- Basic Orientation for Supervisors
- Civil Rights and Diversity for Supervisors (includes Prevention of Sexual Harassment)
- Workplace Safety
- Clinical Supervision Parts 1 & 2 (implemented in 2006)
- Critical Thinking Skills Training (implemented in 2007)
Frontline supervisors who provide supervision to staff investigating/assessing CA/N reports are provided the following training opportunities:
- Legal Aspects for Investigators/Supervisors (implemented in 2008);
Frontline supervisors should also attend a minimum of one of the following courses based on the program area they provide supervision for:
- CA/N Investigation/Assessment In-service Training (implemented in 2005)
- FCS for Intact Families In-service (implemented in 2006)
- Family Centered Out of Home Care for Supervisors (implemented in 2006, but placed on hold due to budget constraints, statewide implementation in 2008).
Frontline workers are provided the following training opportunities:
- New Employee Orientation
- Civil Rights and Diversity
- HIPAA Privacy On-Line; (On-line course)
- HIPAA Security On-line; (On-line course)
- HIPAA Policy; (On-line course)
- Workplace Safety
- Child Welfare Practice Orientation Training, Classes 1-4 and Computer Systems
- Core In-service Training based on assigned program area (CA/N, FCS, FCOOHC, Older Youth Program)
- Domestic Violence
- Per 210 statute staff completing CA/N Reports are required to obtain 20 hours of training annually on the identification and treatment of CA/N
Additional in-service trainings for staff and supervisors have been offered on Professional Ethics and Boundaries, Cultural Competency and Adoption. There are numerous courses offered by the department for in-service training opportunities.
New courses are considered for development as learning needs arise and in conjunction with policy changes and legal mandates.
The existing On-the-Job (OJT) Training Guides for Supervisors and Workers were replaced in 2006 with new guides developed by a group of field staff, supervisors and specialists. The guides were revised in 2008 and again in 2009 following feedback from frontline supervisors and workers. Future plans are to have these placed on-line for use by supervisors and staff.
The content of the guides is based on the competency areas needed by a Children's Services Worker to provide public child welfare services to children and families. The content is cross referenced by competency area and the structure of the Child Welfare Practice Basic Orientation Training. Examples of competency areas included are:
- Can join and engage with families, court personnel, schools, and other professionals
- Can identify indicators of abuse and neglect
- Can facilitate goal setting with a family or team
- Can identify grief and loss reactions
- Can demonstrate a case progress consultation with a supervisor
The guide reflects that within the first year of employment and throughout Child Welfare Practice Basic Orientation Training, Supervisor BOS (Basic Orientation to Supervision) Training, and Clinical Supervision training that worker and supervisor are to be making case management decisions jointly.
There is an expectation supervisors will follow the OJT process in partnership with new staff. The process has built-in completion checklists, and a two-way feedback tool. These tools help guide the supervisor during the OJT process and ensures completion of the entire process while providing evidence of OJT practice continuity across the state. OJT dollars are claimed to Title IV-E training at the 75% rate for a new employee's first three months of employment.
Create Web Based Training
Web-based formatted trainings have been developed in several areas. These trainings are useful in situations where content needs to be delivered to a large number of staff or to lesser numbers of staff spread amongst various geographic areas. The Children's Division has worked with an educational agency which produced the audio/visual content of several trainings. DVD's were also produced for distribution to be used by staff or with agency partners such as foster parents.
Training on 'Adoption and Guardianship Subsidy' was presented by agency PDS and a staff trainer. This training was delivered 'live' and is currently available to staff through the intranet. DVD's were also produced and distributed.
A second training was on 'ICPC'. This was presented by agency staff and is also available to staff through the agency intranet. This training is an audio/visual presentation.
The agency worked in conjunction with community partners to present a web-based training on 'Educational Advocacy'. Presenters included agency staff trainers, the attorney who developed the training and other community partners. This training was delivered 'live' in a video-teleconference format. The trainers broadcast from a central location to several remote sites. Participants were able to e-mail questions to the central location for responses from the presenters. This was made available to all staff by DVD.
Create Interactive Online Modules and Courses
On-line instructional trainings have been developed in several content areas. Most of these trainings are required for front line staff or supervisors. Areas of content include:
- Code of Ethics/CQI Training
- Personnel Health and Safety Training
- HIPAA Privacy
- HIPAA Security
- HIPAA Policy
Initial work has also been completed on an interactive module around worker visit practices with children and their families. This project is not yet completed for statewide use by staff.
There are a number of informational PowerPoint presentations and video-teleconferences available via the agency intranet for staff to use for review and educational purposes. Content includes, but is not limited to: CA/N, CFSR, ICPC, Mandated Reporter Training, MOJJIS, Older Youth Program, Safe Sleep Practices, Random Moment Time Study.
See Annual Professionalism Section for more training information.
Increase staff levels and education
The education program of the CD focuses on social work education for current staff by providing a MSW degree program.
To provide this opportunity, the CD partners and contracts, with the four universities throughout the state that offer an accredited Master of Social Work degree program. This partnership aids the CD to meet compliance with accreditation standards for supervisory staff. In addition, the knowledge and skills learned and used with subordinate staff aid the division to meet the changing needs of children and families. Each contract with a university uses Title IV-E, State, and University funding.
The full-time MSW degree program ended with the graduates of May 2007. The part-time opportunities in the state, from this contract, have expanded to all parts of the state. Three areas are now served by "distance-learning" sites, where the selected staff may attend course work on the campus of that site, as well as on-line courses as appropriate. Greater numbers of staff can be supported with the same funds. The employee remains in their current job and location and can remain involved in the changing policy of the division as well as remain connected to the children and families being served. It also helps retain the more experienced staff as well as help with staffing needs of the division.
To support the central part of the state, which was not served with the ending of the full-time program, up to 11 regular standing students can be selected to begin course work August 2008.
To support the accreditation of the agency, preference is given to first-line supervisors and other CD services administration, such as Children's Services Specialists. In addition to the 20 new regular standing staff which started January 2007, six advanced standing employee-students started in January 2008. All 26 of these students will graduate December 2009.
Contracts in place with all four universities can support a total of 69 employees including those completing their degree as well as new additions. This is as of the new contract year which runs June 1, 2009 to May 31, 2010. Satellite sites are used by the other universities as well. Since funding does not increase yearly, employee-students are replaced only when others graduate. Tuition increases sometimes decrease the number of staff that can be supported when the contract budget cannot increase.
The BSW program for those "preparing for employment" ended May 2008 when the currently selected group of students graduates. Two programs worked with the division to provide August and December graduation dates, in addition to May dates. Those two universities will remain contracted until their students graduate in August and December 2008.
Since the Master's educational program began, assistance has been provided to 298 Children's Division employees. Of those 298, 174 remain employed while 13 retired and 4 are deceased.
- Practice Enhancements
Missouri's strategic plan for supervision
In an effort to improve retention and respond to the needs of its case managers, the State of Missouri's Children's Division developed a strategic plan through a participatory design process using child welfare supervisors, university training partners, and other stakeholders focusing on strengthening supervisory skills and providing additional support to its supervisors.
The idea of creating a supervision strategic plan came about in a meeting in April, 2005. Participants included the Children's Division's director, deputy director, the Federal regional officer from the U. S. Administration for Children and Families assigned to Missouri, two regional child welfare managers, several central office staff, and staff from the National Child Welfare Resource Center for Organizational Improvement (NRCOI), an organization that is part of the Children's Bureau's Training and Technical Assistance (T/TA) Network, U.S.H.H.S. The Division asked NRCOI staff to participate in this meeting to help the Division determine what training and technical assistance could be provided by this T/TA Network to help the Division successfully implement and complete its PIP.
During this meeting, it was noted that many-if not most-of the issues Missouri addressed in its PIP were issues that typically need to be addressed in the course of supervision of child welfare frontline workers or case managers. This led to a discussion about the current practice of child welfare supervision in Missouri. It became clear that the quality of supervision and the support of child welfare supervisors needed improvement. It was decided that the Division would develop a comprehensive strategic plan to improve supervision and better support supervisors, with technical assistance from staff from the NRCOI and another of the Children's Bureau's centers-the National Resource Center for Child Welfare Data and Technology (NRCCWDT). It was anticipated that the implementation of this plan would contribute to better child welfare outcomes and other positive results such as better child welfare worker retention.
Between April and June, 2006, the National Resource Centers (NRCs) staff worked with the Division to create the Missouri Child Welfare Supervision Work Group. Members included respected supervisors from each of the Division's seven regions, one circuit manager, three clinical specialists, three Central Office staff (training, quality assurance, and the CFSR/PIP coordinator). Other members included a case manager who had helped pilot a supervisory case review tool (a requirement of Missouri's PIP), and a University of Missouri training partner who developed a clinical supervision training curriculum through a supervision demonstration grant from the Children's Bureau which was being piloted in Missouri, and three staff of the two NRCs.
The first meeting of the Work Group was held in June, 2005. The Division Director gave the charge to the Work Group, stressed the importance of the work it would do, and promised full support of the Group and its plan.
Three more in-person Work Group meetings were held between June and November, 2005 to complete the draft of the strategic plan. At each of these meetings, NRCs staff noted increasing group cohesion, growing member investment in the work, and building confidence in the quality of the plan. The plan was presented to the Division's leadership (director, deputy director, and the seven regional managers) in January, 2006. Minor changes were made, and the plan was finalized at the end of January. It took eight months to draft and finalize the strategic plan. The plan addressed four core areas, each with goals and action steps:
- Supervisor Training
- for all planned policy and practice changes, train supervisors first;
- train all supervisors in administrative supervision;
- train all supervisors in advanced clinical supervision skills, and develop ongoing supervisor training;
- train all supervisors on using data at the worker and unit level to supervise and mange for results;
- hold an annual supervisor training conference/summit
- Supervisor Support
- establish and implement a structure for the regular, scheduled supervision of supervisors;
- establish and maintain a regularly scheduled peer-to-peer supervisors consultation system (learning labs);
- reduce non-supervisory tasks to increase time for clinical and administrative supervision;
- support for supervisor educational advancement;
- develop a career ladder for workers and supervisors;
- increase supervisor compensation
- Clinical Supervision
- establish regularly scheduled weekly supervision of each worker and unit;
- implement a new supervisory case review tool (SCRT) and process based on the CFSR to be used regularly in conjunction with each worker and which will result in an annual professional development plan for each worker;
- define the role of supervisors in Family Support Team meetings;
- improve access to legal counsel for supervisors
- Management and Administrative Supervision
- develop a consistent expectation and job description for supervisors statewide;
- develop a consistent performance appraisal for supervisors statewide;
- develop a consistent way to count cases;
- adopt a universal supervisor-worker ratio;
- achieve consistency in corrective discipline actions statewide;
- provide supervisors data at the unit and worker levels
For each of these action steps, the Work Group defined (1) tasks; (2) benchmarks; (3) completion date; and (4) persons/groups responsible.
Implementation of the plan began in February, 2006. At meetings in February, March, April, July, and October, 2006, the Work Group reviewed each action step and the status of its implementation. Persons/groups responsible included appropriate central office and field leadership staff, but different Work Group members volunteered to assist and monitor each action step.
At the November, 2006 meeting, implementation of the supervision strategic plan was proceeding well, however, the Division Director identified a need for a standing body of supervisors to continue to provide leadership feedback on the needs of child welfare supervision in Missouri after technical assistance ceased. Therefore, Missouri requested assistance in developing a charter to ensure a standing body with responsibilities and membership parameters.
To make the Supervision Workgroup approach successful, the following elements were identified as essential:
- Participatory Design. The principle of participatory design was used in this process where the persons who will be responsible for implementing the strategic plan be involved in its design
- Member Selection. Regional managers were asked to select a well-respected supervisor from the region to serve on the Work Group. In selecting the best qualified, the group was revered and respected
- Supervisor Buy-In. The workgroup supervisors defined themselves as "ambassadors" for selling the plan to their peers. At regional staff meetings in workgroup members regularly brief the leadership and other colleagues on the latest Supervision Work Group discussion and asked for feedback and suggestions.
- Leadership Buy-In. A critical piece for success is to invite a member of the Executive Team to hear concerns and recommendations.
- Other Work Group Participants. A critical piece of the workgroup is to invite those with expertise to advise and assist the planning and recommending process. For Missouri, the other work group participants were a training manager, QA Manager, CFSR coordinator and a University professor.
A Child Welfare Supervision System. As change agents, Missouri recognizes the need for the supervision workgroup to become a policy review team to review draft policies before implementation. Therefore a distribution listing of all supervisors in the state was created for the policy review process
CFSR Data Indicator Improvements National Standards 2005 2006 2007 2008 Fed Goal Recurrence of Maltreatment 5.00% 4.60% 4.90% 4.10% 6.1% or less Incidence of CA/N in FC 0.39% 0.38% 0.42% 0.26% .57% or less Length of time to achieve reunification 70.22% 68.77% 70.34% 67.04% 76.2% or more Length of time to achieve adoption 39.15% 41.79% 41.05% 38.45% 32% or more Stability of FC Placements 77.18% 79.80% 80.71% 81.32% 86.7% or more Foster Care Re-entries 10.38% 9.44% 8.62% 8.65% 8.6% or less
The table above is an internal measurement outcome produced from the DSS Research and Evaluation Department and uses the federally set benchmarks as goals from the first round of the CFSR.
- The Children's Division met the recurrence of maltreatment every year since SFY05. And, the data indicates constant improvement each year.
- Incidence of Child Abuse and Neglect in foster care was met every year since SFY05.
- The Children's Division struggled every year meeting the length of time to achieve adoption. The outcome is calculated by capturing the total number of children reunified and subtracting those who reunified within 12 months and dividing the 12 month number by the total reunified. In addition to the 12 month timeframe, we tracked children reunified within a 24 month period and we consistently are reunifying at a rate of 90%.
- Repeatedly the Children's Division has met the benchmark for the length of time to achieve adoption. This outcome is calculated by subtracting the date of entry into custody against the date of finalized adoption. The number of children who reached final adoption within a 24 month period, is then divided by the total number of finalized adoption.
- The Children's Division grapple with reducing the stability of a child in foster care. Ideas have been discussed at great length regarding this issue. On a positive note, the state data is showing improvements. The focus on worker visits and in-depth clinical support with enhancing the quality of those visits may have a direct effect on this data outcome.
- For the re-entries into foster care outcome, the state has shown significant decrease during 2005 and 2006, with just barely missing the benchmark in 2007 and 2008. The re-entry issue has been addressed through many avenues, such as: enhancing clinical support, continued focus of data by QA specialists, performance based foster care case management contracts, and use of intensive family reunification services through a performance based contract.
Family and Children's Electronic System (FACES)
Missouri has made significant progress in the development of a single, statewide, SACWIS compliant system. Testing is in progress for the final SACWIS component, Resource Management and Financial Management, which will be implemented in June 2010.
The FACES components that have been implemented include: Intake Management (June 2005), Investigation and Assessment (May 2006), Case Management (December 2007) and Eligibility Determination (November 2005).
FACES introduced on-line, real-time data entry, which afforded the ability to incorporate edits to improve accuracy of data entry. Legacy systems were dependent on overnight batch processing to complete data entry validation, at times resulting in incomplete data entry when workers failed to follow-up with appropriate error resolution.
The web-front end includes full descriptions for selections, instead of simply code values, to improve accuracy of data entry as well as usability.
Automated alerts are generated to help ensure that required actions and follow-ups are completed in a timely manner.
Multi-level approval processes are included in FACES to ensure necessary consultations and reviews are completed.
With the single system, duplication of data entry has been virtually eliminated and data inconsistencies that were prevalent between the eleven legacy systems, that FACES is replacing, no longer exist.
By using DB2 relational database technology, FACES has the capacity to create multi-relational links between widely varied data.
The extensive collection of data in FACES provides valuable information for management to fine-tune program policies and practices, as well as establish new policies and practices to fill voids identified in the provision of critical services to Missouri families and children.
As staff become more comfortable and familiar with the FACES automation and capabilities, numerous system change requests have been submitted to improve usability, support new policies or practices, and include additional edits to improve data integrity, or enforce consistency statewide.
System change requests are evaluated by FACES Change Control Board members who decide whether the change should be made and prioritize those that are approved. Missouri continues to expand and improve FACES functionality to be an integral tool for staff to use instead of simply a data repository.
Key Early Intervention
As mentioned in the last five year plan, the Children's Division intended to develop continually ongoing key early intervention strategies within our service delivery. This was accomplished by expanding and enhancing early childhood programs, embedding the Strengthening Families philosophy in policies and contracts, improving the initial assessment tool, requiring a referral to First Steps for all children under age 3 involved in a substantiated child abuse and neglect report, and requiring referrals to the Department of Health for children involved in a drug exposed newborn crisis assessment.
In-depth information regarding early childhood programs such as: Child Care, Child Care and Development Fund, Early Childhood Development Education, and Strengthening Families through Early Care are located in the Annual Prevention Section.
Ongoing Evaluation of Safety Tools
The safety tool re-evaluation process has been evolving since the embedding of structured decision making protocol in several program areas. Currently, efforts are focused on the re-drafting of a stand alone assessment tool which can be used in CA/N investigations and assessments, Family Centered Services and Out of Home care. In particular, emphasis is placed on enhancing the out-of-home policy for formal safety assessments for children placed in foster and residential care.
Reducing Children Re-entering Foster Care
While the data has steadily improved since the development of the last five year plan (See CFSR Chart above for details) the Children's Division made consistent efforts toward various activities as an attempt to reduce this outcome. These activities consist of the creation of the Intensive Family Reunification Services for foster children returning to the home through a trial home placement. This program allows a worker to provide intensive assistance work with the child's family system while identifying barriers for sustaining reunification. Addressing these barriers timely and intensely are key for a successful reunification.
Additionally, through the Legal Aspects training and various case review processes, CD staff recognizes the need to demonstrate reasonable efforts which keeps workers mindful of the cause for removal rather than addressing the symptoms.
Increase Stability in Foster Care
As the CFSR Chart above indicates, we have made improvements each year since 2005. When Missouri's vision for the next five years was developed, it was expected improvements were possible through early identification of family dynamics to expedite the provision of effective services. While CD did make considerable changes to the assessment process, there is other indicators that may provide an additional explanation for improvements. CD's focus consistently has been to determine the best permanent arrangement for a child in foster care. This determination is made through a family support team approach and suitable relatives are explored in-depth. Using an Excel pivot table of the April 30, 2009 children in foster care, but not in a relative placement, these children experienced on average 3.06 moves. Using the same list, children placed in relative or kin placements experienced on average 1.25 moves.
In addition to the FSTs focus on the placement setting, there are continuous efforts to include children of appropriate age to participate in their permanency planning. Also, the Older Youth Program expansion expects the specialists to assist youth in finding a permanent caring adult in their life which should lead to better stabilization.
- Supervisor Training