Many times, a spate of child deaths will cause systems to overreact, leading to sharp upticks in child removals. In some cases, a myopic focus on those cases has lead to costly, wholesale child welfare reforms in which policies that dictate the decision-making in hundreds or thousands of cases are changed based on a small sample of horrific cases.
In Hillsborough County, Fla., a nonprofit service provider named Eckerd and some of its partners had a different idea. They would study a recent spike in child fatalities in the hopes of developing a plan specifically aimed at preventing other deaths.
The end product is Rapid Safety Feedback (RSF), which combines a baseline of serious risk factors with real-time quality assurance (QA). And so far, the county has experienced zero abuse or neglect fatalities since its implementation.
“It changes the nature of the relationship between us and caseworkers on QA,” said Bryan Lindert, Eckerd’s director of quality management for Hillsborough County.
Instead of voluminous reviews of cases after the worst has happened, he said, “They know we’re going to be coming…during the quarter to look at really critical things, instead of one hundred-plus questions.”
After some early success, the nation’s largest single child welfare system – Los Angeles County – may bring in RSF. Adoption of the system was recommended by a commission established to steer reform of the county’s child protection system after a high profile child death.
Eckerd operates residential and community services for juvenile and child welfare systems in eight states. It is based in Florida, which relies on major contracts with lead nonprofit agencies to operate most of the state’s child welfare system.
In July of 2012, Eckerd inherited the DCF contract to operate Hillsborough County, which includes Tampa.
The organization stepped into a mess. In the previous two years, eight children had died while under the supervision of Eckerd’s predecessor, a home-grown nonprofit called Hillsborough Kids.
The $65.5 million contract Eckerd was awarded in 2012 came with plenty of complexity. Eckerd must manage the involvement of its own staff, law enforcement and case managers from subcontracting organizations in child welfare casework.
“This decision should be a wake-up call for the child welfare community that there needs to be improvement in the governance and oversight,” said Robin Rosenberg, deputy director of Florida’s Children First, speaking with the Tampa Bay Times after DCF announced the switch.
Mike Carroll, DCF’s regional director for the area at the time, who is now the agency’s interim secretary, made the same sentiment clear to Eckerd.
“It came from Mike Carroll that we aren’t interested in QA after a tragedy,” said Bryan Lindert, Eckerd’s director of quality management for Hillsborough County. “We were tasked with finding the highest likelihood of poor outcomes so we can intervene while the case is open, before a problem occurs.”
Lindert’s team studied the 1,500 cases managed by Hillsborough Kids, including the eight fatalities. The goal, Lindert said, was to identify a small set of factors that most corresponded with safety risk.
The primary factor quickly emerged: children under the age of three who are left in their home. Every child who had died in the previous two years fell into that category.
Eckerd then established a nine-question assessment tool to be administered four times each year in cases with three-year-olds at home (Lindert estimates there are about 175 each quarter.)
“These are the nine things that are critical to safety,” Lindert said. “There might be another 10 or 20 that relate to permanency, but we had to get disciplined.”
The questions:
- Is the safety planning sufficient to the risk of keeping the child at home?
- Is the case plan individualized and related to known dangers?
- Is the parent’s behavior change monitored related to risks?
- Is the case manager aware of any emerging dangers?
- Is the quality of contacts sufficient to ascertain and respond to emerging dangers?
- Is the quantity of contacts sufficient to ascertain and respond to emerging dangers?
- Are background checks and home studies sufficient and responded to appropriately?
- Is communication between case managers and the family involved sufficient based on the known dangers at home?
- Does supervision identify concerns in the provision of services, and are those recommendations followed up on in an urgent fashion?
“If we can’t answer yes to all nine, we…call up the case manager and say, ‘We’re seeing this on this case, what’s going on?’” said Lindert. Eckerd will establish agreed-upon steps to rectify the situation with the case manager. The steps are checked off by Eckerd as they are completed.
If those steps are not completed on time, Lindert said, a meeting is held to hold the case manager accountable. “First we’ll ping the case manager again before we contact leadership, then I’ll get involved with their director.”
It rarely gets to that point, he said. “Case manager has people coming in on their case, sharing liability, and giving them ideas they haven’t had maybe.”
Since the implementation of RSF, there have been zero child fatalities attributed to neglect or abuse. One child died while sleeping, the other drowned; the Hillsborough County Sheriff investigated both, and both were “unsubstantiated for abuse and neglect,” said Lindert.
Rapid Safety Feedback may soon become part of the establishment in Los Angeles County, which handles about 80,000 reports of abuse and neglect each year. The commission, which is comprised of local and national child welfare leaders, made a long list of recommendations on practice and organizational structure, including a call for the establishment of a “czar” to oversee child protection.
It also recommended the wholesale adoption of a fatality prevention program that developed by a Florida-based service provider.
From the commission report:
“Remarkably, Hillsborough County achieved a 100 percent reduction in child fatalities,” the commission report said. “This process is effective no matter what the size of the jurisdiction.”
Los Angeles won’t be the first place to adopt Eckerd’s framework. Casey Family Programs funded the Florida Department of Children and Families to train child protection investigators on the system.
In turn, DCF pays for Eckerd to train the rest of the state’s lead agencies on RSF. The state investigators will use it during the investigation process; other lead organizations will use it in the quality assurance fashion used by Eckerd.
Like any systemic shift, there is an upfront cost to implementing Rapid Safety Feedback. Lindert said Eckerd would be able to help develop RSF for a county or state for between $150,000 and $200,000.
John Kelly is the editor-in-chief of The Imprint.
