Children's Voice September/October 2007

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Eye on CWLA

Using the Special Review as a Program Improvement Tool

Three years ago, the Connecticut Department of Children and Families (DCF) contracted with CWLA to develop a Special Review Model for reviewing critical incidents that occur within child welfare cases, including when a child dies. Since that time, CWLA has completed more than 25 Special Reviews for DCF that emphasize learning and improvement of case practice.

Historically, when DCF conducted child fatality reviews, the process tended to cause tension and apprehension among staff, explains CWLA Senior Consultant Andrea Bartolo, who has worked closely with DCF on the project. The review process was considered unnecessarily adversarial, precluding productive professional discussion and opportunities for reflecting on the facts of a case.

"CWLA's Special Review Model facilitates objective review of a case that is also respectful of staff, sensitive to workers' needs for comfort and support, and cognizant of workers' trauma," Bartolo says.

Specifically, the CWLA-DCF Special Review Model
  • reviews circumstances of a fatality or critical incident;

  • assesses case practice and analyzes findings;

  • provides recommendations to improve systems, DCF policy, and organizational competence; and

  • is consistent with DCF's mission, values, and best practices.
CWLA's Special Review process is separate from employee reviews conducted by DCF's Human Resources Unit. Special Reviews are done on both open cases and cases closed within six months of a fatality or critical incident. Cases may also be assigned for Special Review at the discretion of the DCF commissioner.

The Special Review process involves entrance and exit meetings with review participants, a case record review, and interviews with all DCF staff involved in the case, as well as with selected external and collateral providers as appropriate. Participants are assured the reports will not identify individuals or the sources of information.

After interviews are completed and documents reviewed, the review team drafts a written report that is shared with staff before the scheduled exit meeting. Staff are encouraged to contribute by providing corrections and suggestions to recommendations. Based on exit discussions, the team completes a second draft that is again shared with all participants. The final draft goes to the commissioner and senior managers before it is redacted, posted on the department's Intranet, and shared with the DCF Training Academy Director.

Special Review findings and recommendations have led to improvement in many areas:
  • more systematic and collaborative use of mental health resources;

  • more attention to staff secondary trauma during debriefings;

  • training in both assessment and treatment of domestic violence;

  • training on predictors of suicide;

  • training on working with youth who are lesbian, gay, bisexual, transgender, or questioning;

  • expanded supervisory training;

  • family conferencing;

  • family assessment and risk assessment;

  • development of worker support teams; and

  • designing a transfer of learning to practice model.
CWLA is collaborating with DCF on the Special Review project through at least 2010. For more information about replicating the model for other public and private agencies, contact Bartolo at 978/929-9333 or abartolo@cwla.org, or Andy Reitz at 617/769-4011 or areitz@cwla.org.

Keeping Children and Families Front and Center on the Hill

Capitol Hill was abuzz this spring as newly elected and returning members of the House and Senate stepped up their legislative activity. CWLA worked hard to ensure the voices of vulnerable children and families were heard. Through letters, testimony, and partnerships with other organizations, CWLA lent support to a number of different issues related to child welfare.

Kinship Care
CWLA launched the Care About Kinship Campaign in May to build support for the Kinship Caregiver Support Act reintroduced by Senators Hillary Clinton (D-NY) and Olympia Snowe (R-ME) and Representatives Danny Davis (D-IL) and Tim Johnson (R-IL).

As part of the campaign, CWLA members were urged to contact and ask their Senators and Representatives to cosponsor the bill, and CWLA and other organizations convened a Capitol Hill briefing on, "Children Being Raised by Grandparents and Other Relatives." For a Senate Finance Committee hearing, "Keeping America's Promise: Health Care and Child Welfare Services for Native Americans," CWLA submitted testimony on Title IV-E access to tribes and the benefits of passing subsidized guardianship legislation.

Mental Health
CWLA endorsed the Mental Health Parity Act of 2007 by Senators Edward Kennedy (D-MA), Michael Enzi (R-WY), and Pete Domenici (R-NM). The legislation would require businesses with more than 50 workers to provide mental health coverage equal to coverage for other medical conditions.

Child Protection
CWLA endorsed Senator Christopher Dodd's (D-CT) Shaken Baby Syndrome Prevention Act during National Child Abuse Prevention Month in April. The bill would appropriate $10 million for FY 2008, and funds as necessary for FYs 2009-2011, to develop a public information campaign aimed at preventing Shaken Baby Syndrome (SBS).

Foster Care and Education
CWLA and other organizations issued a position statement on the education needs of children in foster care. As part of the reauthorization of the No Child Left Behind Act, CWLA sent a letter to Congress asking it to clarify language in the reauthorization of the McKinney-Vento Homeless Assistance Act, which includes provisions on the educational needs of children who are homeless or awaiting foster care.

The law is interpreted inconsistently among states because it is unclear as to whether children in foster care are covered under the law. The position paper makes several other recommendations on how to strengthen access to education for children in care.

Health
CWLA joined many advocacy groups urging Congress to reauthorize the State Children's Health Insurance Program (SCHIP) and provide $60 billion in new federal funding for children's health over the next five years. That funding would allow states to enroll most uninsured children already eligible for Medicaid and SCHIP, and support coverage for more children.

CWLA signed onto a letter by the National Immigration Law Center urging Congress to support the Legal Immigrant Children's Health Improvement Act, granting states the option to cover pregnant women and children who have entered the country, lawfully since August 22, 1996. Current law bars this population from receiving SCHIP and Medicaid for five years.

CWLA and other organizations sent letters to the Centers for Medicare and Medicaid Services (CMS) urging them not to implement a proposed rule that would have greatly restricted Medicaid services to the child welfare population. The new rule would have significantly reduced public providers' already low reimbursement rates and squeeze state budgets.

The League signed onto a letter sponsored by the American Academy of Pediatrics urging Congress to provide an additional $10 million to the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control to establish a consortia on the medical aspects of child abuse and neglect. The consortia would link an array of medical providers who are positioned to identify at-risk children and families and intervene before maltreatment occurs.

To shed light on how federal policy influences health coverage for children in foster care, CWLA organized a Capitol Hill presentation in May that featured pediatrician David Rubin, Director of Research and Policy for the Safe Place: The Center for Child Protection and Health at the Children's Hospital of Philadelphia, and two foster moms as speakers.

Substance Abuse Prevention and Treatment
CWLA was among the signers of a letter requesting the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, and Education to provide $1.9 billion for the Substance Abuse, Prevention, and Treatment Block Grant--the backbone of publicly funded substance abuse service systems. The block grant has been cut by some $20 million over the last three years. For FY 2008, the Bush Administration proposed only level funding.

Child Welfare Financing
CWLA joined seven other national organizations to unveil a proposal last spring for comprehensive reform of child welfare funding. Current Title IV-E eligibility requirements would be eliminated, funding would be extended to intervention and prevention services, and any effort to convert Title IV-E into a block grant would be rejected. The proposal also recommends Title IV-E coverage be extended to kinship and guardianship placements.

National Summit on America's Children
CWLA President and CEO Christine James-Brown represented CWLA at the bipartisan National Summit on America's Children, assembled by House Speaker Nancy Pelosi (D-CA) on May 22. The daylong Capitol Hill event convened national experts and academics on recent scientific findings and how they relate to early childhood development.

For the latest on CWLA's advocacy work, visit www.cwla.org/advocacy.
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