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Child and Family Services Agency Performance Oversight Hearing, Fiscal Year 2014-15

Friday, February 20, 2015
Testimony of Raymond Davidson, Interim Director

Good morning, Chairperson Alexander and members of the Committee on Health and Human Services. I’m Ray Davidson, interim director of the DC Child and Family Services Agency. I appreciate this opportunity to discuss the performance of the Agency over the past year with you.

From childhood, all of us know the story about a train that reached a goal through positive persistence: “I think I can, I think I can, I think I can.” In that same determined spirit, CFSA has gone from being an agency that could to one that can and does. In returning from Federal Court receivership to city control in 2001, we decided we could become a high-performing child welfare agency. Today, after more than a decade of reform, we can point to some two dozen best practices we’re using to go far beyond the mandates of federal and court authorities in providing quality child welfare services. And as I will illustrate throughout my remarks, CFSA does have a positive impact on many of the children, youth, and families we serve. CFSA is not perfect. We continue to strive to improve. At the same time, we have in many ways become the high-performing child welfare agency that our most vulnerable District residents need and deserve.

Background: Four Core Mandates

I want to set the stage with a quick overview of child welfare requirements. All child welfare agencies in the U.S. have four core mandates that stem from federal laws and regulations.

  • The first is to: Take and Respond to Reports. Child safety is always Job One. We must have a way for people to report child abuse and neglect. CFSA operates the District’s 24-hour hotline at 202-671-SAFE. It’s important to understand that child welfare must have a report in order to act. Calls about situations that fall within the District’s legal definition of child abuse and neglect trigger a response from CFSA.
  • Our second mandate is to: Help Families. When child victims and those at risk come to our attention, we must have services available to help parents overcome difficulties and keep their children safe.
  • Third, we must Maintain Alternative Safe Havens. For children who can’t be safe with their parents, we must have safe, temporary, alternative places for them to stay. And while children and youth are with us, we have an obligation to give them the very best care we can.
  • And finally, the fourth mandate is to: Reinstate Home. We have an obligation to provide children with a safe, permanent home as quickly as possible—with their parents, with a legal guardian (who is often a relative), or with a new adoptive family.

For CFSA, these core functions have become the springboard for developing a much more robust vision and system of care for child victims and their families.

Service Demand and Demographics

I’d like to take a moment to discuss the local demand for child welfare services.  In FY14, CFSA’s hotline received more than 31,000 calls. Just over 11,000 of these calls were reports of abuse/neglect. CFSA Child Protective Services accepted and responded to close to 6,000 of those reports (53%), and substantiated 877 instances of abuse and/or neglect. Our local substantiation rate of 25 percent is in line with the national average.

As of December 31, 2014, CFSA was serving 2,812 District children and youth, including 1,740 (62%) in their homes and 1,072 (38%) in foster care. Of the children in foster care, 95 percent were African-American and about equally divided between males and females. A little more than half (53%) were older youth, ages 13 to 21. Approximately 72 percent of children in care come from Wards 7 and 8, and another 14 percent come from Wards 5 and 6.

In FY14, 65 percent of entries into foster care were a result of neglect, and 23 percent due to physical abuse. Behind these statistics are the many social issues that child welfare social workers typically confront such as:

  • Untreated or sporadically treated health or mental health issues.
  • Parental incarceration.
  • Parental substance use (especially PCP).
  • Poverty.
  • Undiagnosed or underserved developmental disabilities.
  • Inadequate or unstable housing.
  • Domestic violence.
  • Unstructured or violent parenting styles, often perpetuated through generations.
  • Child or youth behavioral problems or other special needs.
  • And more and more, we seem to be seeing single parents overwhelmed by a large family with multiple issues.

Key Trends and Accomplishments

Under the leadership of my predecessor, Brenda Donald, CFSA has undergone a dramatic transformation. Five trends and accomplishments stand out, and together they paint a picture of the current state of the Agency.

First Trend and Achievement: CFSA is Self-Directed and Self-Monitoring
CFSA’s agency-wide strategic agenda, the Four Pillars, has turbocharged achievement of improved outcomes for children, youth, and families. As I describe each pillar briefly, you’ll hear an echo of the four mandated functions I talked about a moment ago—and you’ll understand how the Pillars tie our actions to important values about the best interests of children. Briefly, here are the Four Pillars.

  • The first pillar, Narrowing the Front Door, speaks to ensuring that more children grow up with their families, so we remove children from home only when necessary to keep them safe. In the past, the District had a very high removal rate compared to the national average. Today, our focus is on providing support so families can stay together safely.
  • The pillar, Temporary Safe Haven, motivates us to ensure that foster care is a good but interim place for children to live while we work to get them back to a permanent home as quickly as possible.
  • The Well Being pillar stands for every child’s right to a nurturing environment that supports healthy growth and development, good physical and mental health, and academic achievement. Institutions don’t make good parents. But when we must bring children into care for their safety, this pillar calls on the public agency to be the best parent we can.
  • Finally, the Exit to Permanence pillar is about ensuring that every child and youth leaves foster care as quickly as possible for a safe, permanent home or life-long connection and that older youth in care master the skills needed to succeed as adults.

A very important point is that the Four Pillars, which have now guided and inspired the local child welfare community for more than two years, are self-generated—that is, entirely home-grown with input from a broad group of stakeholders. This is CFSA getting in the driver’s seat and setting our own ambitious course for local child welfare. It’s a proactive posture in sharp contrast to needing external orders from a court or other authority to set our direction.

Second Trend and Achievement: CFSA is Meeting Rigorous Performance Standards

CFSA has measurably improved performance. We have completed 82 percent of 88 demanding standards in the court-ordered Implementation and Exit Plan under the LaShawn lawsuit. In addition, local stakeholders helped us develop a set of indicators to monitor performance against the Four Pillars agenda. We track these quarterly and post them on our website. Here are some performance highlights from FY14.

  • Help we provide appears to have a lasting effect. The District has very low rates of children re-entering foster care and being repeatedly reported as maltreated—below 6 percent in each instance. This is at or below the national standards for these indicators.
  • The many improvements we’ve made in placement are paying off. Eighty-three percent of children and youth in care are in a family home, either with a relative or a licensed foster parent. Only 9 percent of youth are in a group home or Independent Living setting, and we have brought the number of youth in residential treatment down to 1 percent.
  • We have greatly reduced short stays in foster care, which raised a red flag with community advocates a few years ago. In FY10, 23 percent of exits occurred within a month of entry. By FY14, that same measure was down to 6 percent.
  • Alternative Planned Permanent Living Arrangement (or APPLA) is a goal that consigns youth in care to aging out without permanence. CFSA’s efforts to stop our long-term over-reliance on this goal have led to a 25 percent reduction since 2008. We are pushing harder to ensure youth achieve permanence.
  • We continue to increase emphasis on the well-being of those we serve. In FY14, 96 percent of children got a health screening before entering foster care. In a new strategy we’re ramping up, 85 percent of children ages 0 to 5 got a developmental screening upon entering care.
  • Continuing a trend, FY14 exits from foster care (597) exceeded entries (394) by a ratio of 1.5 to 1. A total of 188 children or youth left care to return to their parents, 163 entered legal guardianships, and 105 were adopted.

Third Trend and Achievement: CFSA Is Leading Local Child Welfare in a New Direction in Tune with Community Needs

As a result of narrowing the front door, District child welfare is undergoing a major transformation from decades as a system with a high child removal rate and geared primarily for foster care to a new posture as a system focused on strengthening families and keeping them together. A clear indicator of the shift underway is that at the end of FY10, CFSA was serving 49 percent of children in foster care and 51 percent at home. By the end of FY14, that caseload balance had shifted to 38 percent of children in foster care and 62 percent at home. We expect this trend to continue.

Fourth Trend and Achievement: CFSA Has Attracted Federal Support for the New Direction

We will only success in narrowing the front door if the District has a broad array of other services and supports that meet family needs. In FY13, as a result of CFSA’s competitive proposal, the District joined 34 states in gaining approval as a Child Welfare Demonstration Project site from the U.S. Department of Health and Human Services. This gives CFSA the flexibility to use funds from Title IV-E of the Social Security Act (the primary source of federal child welfare funding) previously earmarked only for foster care to test innovative solutions to serving at-risk children and families.

Beginning in FY14 and over the next four years, CFSA is using participation in the IV-E waiver to increase investment in our growth area, which is preventing child abuse and helping families keep their children safe without entering foster care. We call our local program Safe and Stable Families. It supports development of a host of community-based services that bring best practices to bear on gaps in supporting families, particularly those with young parents of young children.

Fifth Trend and Achievement: CFSA is Spearheading a Major Drive to Improve Clinical Skills and Practice

In 2012, CFSA won a five-year, $3.2 million grant from the U.S. Department of Health and Human Services to make trauma-informed treatment the foundation of serving children and youth in the District’s child welfare system. Over the past two years, CFSA has worked with national experts to train nearly 3,000 child-serving professionals within CFSA and throughout the community in the cutting-edge techniques of Trauma Systems Therapy (or TST). We are now at the point of introducing a set of screening and assessment tools that will aid social workers in identifying child, youth, and caregiver issues and strengths and point them toward service pathways that will help and heal.

Nearly all clients of child welfare have suffered multiple traumas by the time they come to us, so building the clinical skills of child-serving professionals to help is the absolute best thing we can do to make a positive difference for these children. This strategy is also part of our larger focus on well being that includes child health, mental health, social and emotional development, academic performance, and mastery of life skills. Again, this is a step CFSA is taking not because someone ordered us to do so but because we know it’s the right thing to do. Our vision of high performance goes far beyond mandates.

Partnerships

I’ve been talking about how CFSA has improved in serving abused and neglected children and their families, but I also want to make clear that we aren’t making these strides alone. CFSA is the child welfare agency, not the child welfare system. In fact, the local safety net is composed of a network of child-serving partners all playing critical roles. Among these are: police, attorneys, judges, doctors, counselors, principals, and teachers. About half of the District’s child welfare caseload is privatized, with providers under contract managing cases and providing foster home and congregate care settings. The Healthy Families/Thriving Communities Collaboratives, which have long been a unique local resource, are now at the heart of our Safe and Stable Families development of new community-based services. Child advocacy groups recommend improvements and work with us to implement them. We would be lost without the community members who step forward as foster and adoptive parents.

Over the past few years, these partnerships have grown stronger, leading to a higher level of cooperation and collaboration that is all to the benefit of vulnerable District residents. For example:

  • The DC Department of Human Services and DC Department of Behavioral Health now have staff co-located at CFSA and working with us to quickly assess and serve families who need an array of services.
  • CFSA social work units serving families at home are based in the community with the Healthy Families/Thriving Communities Collaboratives and provide services jointly in many cases.
  • Just as CFSA has come a long way with child welfare reform, DBH continues to develop a robust system of care for mental health. DBH core service providers are also being trained in Trauma Systems Therapy.
  • CFSA worked with advocates and other community stakeholders to develop a Bill of Rights for Youth in Care.
  • The National Center on Substance Abuse and Child Welfare chose the District as one of two cites nationally to receive in-depth technical assistance. With their help, CFSA and the DC Addiction Prevention and Recovery Administration spent a year improving access to substance abuse treatment for CFSA clients. One of the earliest benefits, among many, was reducing the wait time for services from 30 days to two days.
  • DHS and CFSA have developed a model protocol for tighter cross-system collaboration when three or more District Government agencies are all involved with the same family. The first phase is on schedule to roll out this spring.

Honestly, it was difficult to choose just these few examples from among the many significant collective efforts underway. CFSA greatly values all our partnerships and how much good relationships, shared goals, and active teamwork have strengthened the local safety net.

FY15 Priorities

Looking at FY15, CFSA is continuing to pursue ambitious strategies to improve performance in line with our Four Pillars vision and outcome goals. Here’s a short list of our major priorities.

  • Embed the trauma perspective firmly in our day-to-day practice, making our approaches to helping and healing more effective for all those we serve, especially the most deeply troubled.
  • Support more aspects of well being so that children, youth, and families increasingly experience our help as supportive, individualized, and caring and so they move on from our involvement with greater stability, capability, and hope.
  • Continue to support development of community-based services that embody best practices in child abuse prevention and family support, leading to a nuanced array of services ranging from one-time or short-term supports to long-term intensive assistance, depending on the needs of the children and family involved.
  • Tighten cross-system collaboration through launch of the unified case planning model with key players in the District Government’s human services cluster.
  • Bear down on areas of performance in need of improvement against the Four Pillars outcome indicators and LaShawn benchmarks with the goal of achieving and institutionalizing high standards and exiting court oversight.

Conclusion

I’ve talked at length today and have provided a great many facts and statistics. In closing, I’d like to bring it all together with a true story. It gives a glimpse into the daily work at CFSA and also shows how new practices are resulting in better outcomes for those we serve. It’s about a 16-year-old boy I’ll call Sam.

Sam had been in foster care since age 10, and was not a happy teen. He was gloomy and angry and developing a tendency to run away. Last spring, during four months in a new foster home, Sam ran away several times, pushing the patience of his foster parents to the limit. They found Sam’s inability to settle down and their worry about him out on the streets to be very stressful. The foster parents had done a great job with other children, but they were starting to think Sam didn’t belong in their home.

Bouncing around in foster care is terrible for kids. The social worker wanted to prevent the placement disruption if possible—and she also really wanted to help Sam. In a leap forward from just a couple years ago, the social worker confronted this situation with better insight, deeper clinical skills, and new resources gained through CFSA’s trauma work. Here are the major steps she took:

  • When Sam came back from his latest running episode, the social worker and CFSA’s consulting clinical psychologist (who is our in-house trauma expert) were at the foster home to ease the re-entry and offer immediate support for both Sam and the foster parents.
  • With kids like Sam, the impulse is to ask, “Why is he so bad?” But our trauma work teaches us a more productive approach, which is to ask, “What has he been through?” The social worker dug deeply into Sam’s background. Together, she and the consulting psychologist gathered facts and worked with Sam to identify the lingering traumas upsetting him.
  • CFSA uses a best practice called RED Teams (for Review, Evaluate, and Direct) for structured situation analysis and decision making throughout the life of a case. At the scheduled RED Team meeting to look at Sam’s placement instability, the social worker made sure all the professionals on Sam’s service team attended: the attorney, guardian ad litem, consulting psychologist, therapist who had been working with Sam for several months, and the foster parents. The genogram of Sam’s family and comprehensive history of his many traumas enlightened everyone and got them all on the same page. From that collective understanding, they developed a plan of how best to work together for Sam.
  • Two key issues for Sam were the death of his mother when he was a young child and his current relationship with his troubled older brother. The social worker delved into records and the trauma-expert psychologist engaged the birth father to get Sam the answers he craved about his mother’s life and death. They also supported Sam in keeping in touch with his brother while standing firm about his own ideas and not being swayed by any negative influence.
  • As the service team addressed Sam’s unresolved grief, loss, and trauma in a skillful and caring way, he began to calm down, and his episodes of running away stopped. Understanding the importance to Sam, his foster parents forged a connection with Sam’s birth family. The happy ending of this phase of Sam’s story is that not only did he stay in the placement but last fall, the foster parents petitioned to adopt him.

Children and youth come into the child welfare system through no fault of their own. Too often, they have been let down by the people closest to them. CFSA has a moral and legal obligation to do the very best we can to protect, support, and heal these young victims. When our best efforts aren’t enough, it’s tragic. But when we succeed, it’s priceless. Thankfully, those good outcomes are mounting.

Chairperson Alexander, I look forward to our partnership with you and this committee as we take CFSA’s performance to the next level. Thank you, and I’ll be glad to answer any questions you may have.