The next step: Reports on new Hampshire's child protection system detail challenges and opportunities

Several reports from the last two years document recent improvements in NH's child protection system, as well as several remaining challenges

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October 27, 2004

Eric L. Monitor's report, February 2004

Eric L. is a federal class-action lawsuit brought in the 1990s against New Hampshire on behalf of abused and neglected children. It resulted in a five-year settlement agreement that required serious reforms, and created an Oversight Panel to monitor the state's compliance with those reforms.

In September 2002, as time was running out on the agreement, the Oversight Panel judged that while DCYF had made significant progress in several areas of the agreement, "the areas in which there is the most noncompliance are those which most directly impact the well being of the children and the families covered by the agreement . . ."

After discussions between lawyers for the state and for the children, a tentative agreement was reached. But the Legislature's joint fiscal committee refused to settle the suit by approving spending for additional DCYF positions. The case has been turned over to a court-appointed Special Master for findings and recommendations, and the settlement agreement has been continued.

The February 2004 report by DCYF's own Monitor for the Eric L. agreement illustrates both how much progress DCYF has made in some areas, and how much work is needed in others.

Thanks to additional child protective social worker positions in the 2004-05 budget, DCYF had 199 child protective social workers as of the end of September, 2004, a 20 percent increase from 2001. Those new workers, along with the implementation of a Structured Decision-Making system to guide decisions at key points in child protective services cases, helped DCYF:

-- Move children to permanent homes faster, by increasing the percentage of terminations of parental rights completed within 195 days (of the decision to seek them) from 70% in 2001 to 83% in 2003.
-- Make children safer and families more stable by decreasing the number of investigations of reports of abuse or neglect that take more than 60 days to complete from 2,974 (July-Dec. 2001) to 623 (July-Dec. 2003).
-- Meet the health needs of more foster children by increasing the percentage of children who have a health exam within 30 days of being placed out of their homes from 56% (July-Dec. 2001) to 85% (July-Dec. 2003).
-- Conduct more-accurate assessments by checking the information received in child abuse or neglect reports with a second person in every assessment conducted between July and December 2003.

The Monitor's report also identified some continuing weaknesses:

-- DCYF policy and the Eric L. agreement require that caseworkers check on children in family foster homes by visiting them monthly. In the second half of 2003, only 44 percent of children were visited an average of once a month.
-- Federal law requires that states make moving children into permanent homes a priority. Abusers must have their parental rights terminated when a child has been in foster care for 15 of the most recent 22 months. Only 16% of N.H. foster children spend fewer than two years in foster care before being adopted.
-- Too many children "age out" of  foster care without the skills and supports they need to thrive as adults. DCYF policy requires documentation of a child's independent-living needs and the creation of an adult living plan for children who are in placement. That plan should be in place either within 30 days after their 16th birthday or within 30 days of entering placement at age 16 or older. Those plans were completed on time in only 43% of the cases.
-- Although the need for specialized foster homes has never been greater, the number of foster homes has declined from 672 to 659 between 1998 and 2003.

Child and Family Services Review, U.S. Children's Bureau, 2003

In September 2003, the U.S. Dept. of Health and Human Services' Children's Bureau released its Child and Families Services Review (CFSR) of New Hampshire. The review (links to HTML or PDF) concluded that New Hampshire's child protection system needed improvement in eight of the 14 areas it examined, including nearly every area related to children's safety, permanency and well-being.

The report used 1999-2001 data, reviews of 50 cases from three district offices, a self-assessment, interviews, and focus groups to judge whether DCYF practice conforms to federal requirements. The report looked at "systemic factors" (whether the state's processes, standards and services are accurate) and "outcomes and indicators" (whether kids are actually being protected and families are receiving effective services).

DCYF's systems fared much better than its outcomes. The agency's systems were in "substantial conformity" with federal standards in five of the seven areas examined. Only one outcome in seven made the grade.

The federal Child and Families Services Review cited two areas in which New Hampshire's child protection system was particularly weak:

It found that DCYF was too slow in returning children to their homes or into adoptive homes. And it found that DCYF "did not consistently address underlying issues that posed a risk to children, such as domestic violence, substance abuse, or sexual abuse, resulting in a lack of appropriate service provision."

The nearly two-year time lapse between the data and the final Child And Family Service Review report meant that when it was released, DCYF had more-recent data that showed compliance with one additional outcome, significant improvement in two, and a decline in one.

A 50-case sample cannot present a totally accurate picture, even in a small state like New Hampshire. But the federal review is the best effort yet at monitoring states' child protection work, because it supplements case studies with three years of data and the observations of parents, professionals and other stakeholders. DCYF has found the review credible enough to replicate it within its own quality improvement program.

A state agency alone cannot provide safe, permanent homes for children and connect families with the services they need. An effective, efficient child protection system includes the courts, police, schools, health professionals, domestic violence workers and communities. All have a role -- as do our political leaders -- in solving some of the issues identified by New Hampshire's federal review: unreasonably high caseloads, court-related delays, and the lack of specific services in many communities. The report specifically cited the lack of substance abuse treatment and mental health services, both of which have seen significant reductions in state funding during the 2004-05 biennium.

Areas where the federal review found N.H. in need of improvement also included:

-- Assessing safety issues in children's homes;
-- Assuring that children in foster care visit their families ;
-- Meeting the needs of children and families by involving them in case planning and providing appropriate services;
-- Visiting with children or parents frequently enough to monitor children's safety and well-being;
-- Assessing and meeting children's mental health needs;
-- Holding permanency hearings within 12 months of a child entering foster care;
-- Achieving terminations of parental rights;
-- Availability of substance abuse treatment and mental health services; and
-- Consulting with consumers, service providers, courts, and other stakeholders.

Strengths included:

-- Investigating child maltreatment reports in a timely manner;
-- Providing services to prevent children's removal and reduce the risk of harm;
-- Placing children close to their biological families and with their siblings, when appropriate;
-- Preserving children's connections to family, faith, community, culture, and friends;
-- Meeting children's educational, physical health and dental health needs;
-- Reviewing each child's status in court at least every six months;
-- Foster and other caretakers can participate in hearings;
-- A quality assurance system;
-- A staff development and training program;
-- Coordinating services or benefits with other federal programs; and
-- Recruiting foster and adoptive families that reflect children's ethnic and racial diversity.

States can be fined for failing to meet federal requirements -- in New Hampshire's case, $200,461. Each state must put in place a Program Improvement Plan that addresses all of the areas they need to improve. Non-compliance in later reviews increases the penalty.

DCYF's plan contains "key activities" that could greatly improve the agency's ability to provide safety, permanency and well-being to children. Much depends, however, on the governor, Legislature and Health and Human Services commissioner committing sufficient resources to DCYF, which has rarely happened in the past.

Those activities are:

More complete integration of Structured Decision-Making (implemented by DCYF in December 2001) into the agency's child protection work.

Structured Decision-Making is a tool developed by the National Council on Crime and Delinquency's Children's Research Center. It gives workers simple, objective, and reliable guidance, based on best practices, and is based upon:

-- Criteria that are clear and consistently applied
-- Practice standards that can be measured
-- Clear expectations of staff

Creating Permanency Planning Teams to ensure that teens achieve their goals for living independently.

Each district office team will include a child protection social worker who specializes in permanency issues, and another who specializes in adolescent issues.

Restructuring its Case Practice Review system to conform to the Child and Families Services Review. DCYF's Bureau of Quality Improvement rotates reviews of each district office to "develop, analyze and disseminate reliable and timely information -- including performance data -- about the status of child welfare, child protection and juvenile justice."

Train district office staff in protocols developed by the NH Court Improvement Project for cases involving abuse and neglect and permanency planning. The goal is to make court reports and hearings more efficient and timely.

Expand the Permanency Plus program.

Permanency Plus combines DCYF, home-based counseling, and a "resource family" for children and their parents when children enter out-of-home care for the first time.

The combined services begin working immediately with the family to develop supportive relationships, a visitation plan, and a case plan focusing on resolving the problem as soon as possible. If a child cannot safely return home, the resource family becomes his or her permanent family. The program is in five district offices, and a waiver could expand it to three or four more.

Child Welfare League accreditation report, January 2004

The brutal murder of 21-month-old Kassidy Bortner in 2001 cast a spotlight on the state's inability to respond effectively to some cases of child abuse and neglect. In response, Gov. Craig Benson signed the Kassidy Bortner Child Protection Accountability Act into law in 2003. The Bortner Act required the Dept. of Health and Human Services to develop a plan for DCYF to achieve accreditation by the Council on Accreditation for Children and Family Services, Inc.

The report, "Feasibility, Costs and Outcomes Associated with the Pursuit of Accreditation by the Division for Children, Youth and Families" was researched and written by the Child Welfare League of America and released by DCYF in January 2004. The report suggests that accreditation is both affordable and attainable. "DCYF is well positioned, organizationally, to pursue … accreditation … and would be successful in its pursuit," the report concluded.

The report estimates that DCYF could achieve accreditation within 14 to 16 months with additional cost of only $219,800, or 0.17% of the agency's FY 2005 budget. The major recommended cost would be the hiring of four social worker coordinators ($191,800) to head off what the report's authors called "a brewing crisis with case supervision."

"A supervisor-worker ratio that does not approach best practice sets the stage for troublesome case practice and undermines the great strides made by DCYF to date" the report said. It said a supervisor-worker ratio of no more than 1:6-7 leads to quality services, less worker turnover and fewer case crises. Supervisors in half of the 12 district offices had ratios of 1:7 or greater.

The CWLA consultants also suggested that several reforms would be needed for accreditation, including:

-- A cohesive and organization-wide quality improvement plan;
-- An expended case review process that produces quality-related data;
-- More diligence in completing case records online;
-- Monitoring individual worker caseloads and having procedures to address "spikes."

At the legislature’s request, the CWLA report quantified the impact accreditation would have on abused and neglected children, using 14 indicators.

The report concluded that in an accredited DCYF:

-- Abuse and neglect assessments will be completed within 60 days in at least 85% of cases.
-- Cases of repeat maltreatment will be 2.5% or lower.
-- Children will be removed from unsafe living arrangements in every case that warrants a removal.
-- A comprehensive assessment of a family’s risk and safety factors will be completed for every report of child abuse or neglect that is investigated.
-- Services to family members will be provided or arranged in 90% of cases.
-- With the exception of low-risk cases, children in the care of DCYF and their families will have face-to-face visits with a professional at least monthly in 90% of cases.