In a report sent to Los Angeles County’s Board of Supervisors on June 30, Michael Nash, the director of the county’s novel Office of Child Protection, called for the termination of a program that had been a marquis recommendation of the very commission that created his position.
The launch of a “public health nurse program” was one of the top recommendations of the Blue Ribbon Commission on Child Protection. The body was formed in response to a 2012 report that criticized the county’s investigations of child abuse followed by the brutal death of an 8-year-old Palmdale boy at the hands of his mother and her boyfriend in 2013.
The program, which pairs public health nurses and child-abuse investigators during investigations of maltreatment for children under the age of 2, won the unanimous support of county supervisors and was launched in August of last year.
Nash wants to see the program stopped, and added that the larger slate of recommendations offered by the original blue ribbon commission were more akin to guidelines than marching orders.
“There is stuff in there that is never going to happen and that shouldn’t happen and that is not relevant to the operations of the OCP [Office of Child Protection],” Nash said. “We are going pick and choose the things that we need to work on.”
In the first report issued under his tenure, Nash said that the nascent public health nurse program – tested in three sites across the county– had done little to improve child safety. Despite evidence that the program been successful in linking families up to health insurance and identifying the unmet medical needs of vulnerable children, Nash deemed it expendable.
The program would cost $19.6 to $25 million dollars to expand countywide, prompting the former presiding judge of the county’s expansive juvenile court to question whether it would be the best use of limited funds.
“At the end of the day, I think that there just wasn’t enough there that would justify the expense of this pairing,” Nash said.
But the two supervisors who issued the motion creating the public-health nurse program remained unconvinced. Staff for another supervisor bluntly said that Nash’s recommendation was a “really bad idea.” And the report itself lacks any data supporting the claim that child safety was not affected.
Supervisor Mark Ridley-Thomas, who was a key force behind the creation of the blue ribbon commission in 2013, said that Nash’s assessment that the program should be terminated was premature.
“This is a piece of reform that has been implemented for barely nine months,” Ridley-Thomas said. “Innovation doesn’t always yield or reveal immediate results.”
The supervisor also questioned Nash’s argument about the cost of the program.
“No one said that child welfare reform was cheap, and we shouldn’t be trying to do it on the cheap,” Ridley-Thomas said. “We believe that this system needs repair. My view is that we need to be prepared to pay for that repair in the interest of child safety and protection.”
When Supervisor Sheila Kuehl joined Ridley-Thomas in issuing the January 2015 motion creating the program, she was clear that she did not want to see it abandoned before it had a chance to prove its merit.
During the board meeting when the motion was introduced, Kuehl said:
“It’s important that we are not calling this a pilot program because I don’t think it was our intention, certainly not the blue ribbon commission, to say: ‘Let’s try this only in a few places and stop.’”
The supervisor stood by her initial statement after reviewing Nash’s recommendation.
“I am not backing away in terms of what I said about this being a good thing,” Kuehl said.
“I am not of the mind to act so precipitously,” she said. “But I don’t believe that it is wrong-headed of the head of the OCP to recommend what he thinks is right. Our job is to evaluate the recommendation, look at the data and talk to Mike [Nash] about this, and take action, or hold off.”
Nick Ippolito, the assistant chief of staff to Supervisor Don Knabe, the sole vote opposing Nash’s appointment as OCP director in October of last year, said that his boss had been focused on “teaming approaches” like the public health nurse program for a long time.
“This is the first opportunity to do it in a significant way, and I think it would be a really bad idea to throw it out the window,” he said.
While the supervisors remained unsure of next steps, Philip Browning, the director of the county’s Department of Children and Family Services (DCFS), said that he agrees wholeheartedly with Nash’s recommendation to terminate the public health nurse program.
“We looked at the same data,” Browning said. “I am comfortable with that recommendation.”
Browning added that he needs to hire 1,000 new social workers to bring caseloads down and that the millions of dollars it would cost to take the program countywide could be better spent.
“Given a choice, I would say we need more social workers,” he said.
In January of 2015, the County Chief Executive Office sent the Board of Supervisors a plan for the phased-in rollout of public health nurse program. The plan included outcome measures that would be used in determining whether or not the program should be expanded beyond the test sites.
This included three safety measurements: “number of children returning to the child welfare system (detained), number of child fatalities and number of children with a recurrence of maltreatment.”
Despite this explicit guidance, the data DCFS sent to Nash’s Office of Child Protection that was the basis of the report did not include any mention of these safety measures.
Amara Suarez, a spokesperson for the department, said in an email that the data covered the first seven months of the program. This period, she said, “was insufficient to reliably evaluate the following outcome measures: the number of children returning to the child welfare system, the number of child fatalities and the number of children with a recurrence of maltreatment.”
When queried about this lack of evidence, Supervisor Ridley-Thomas said that the report might need more work.
“We will have this conversation with Judge Nash, and as I said, this process is dynamic,” he said.
