1. family and parenting
2. children

Tennessee Quality Services Review
Review Year 2010-2011
Statewide Regional Summary
Including
Brian A., Delinquent,
And Non-Custodial Cases
Acknowledgments
Quality Service Review (QSR) is a process requiring the coordinated efforts of regional staff,
reviewers, partner agencies, and interviewees. Special thanks to regional QSR Point People and
supportive staff for their organization and coordination of the regional reviews: Tyran Copeland
and Amanda Schrock, Davidson; Jackie Stewart, East; Amanda Jones, Knox; Andrea Baker,
Mid-Cumberland; Jamie Perkins, Northeast; Stephanie Coleman and Allison Downs, Northwest;
Delsia Stokes, Shelby; Wendy Williamson, Smoky Mountain; Chris Griffy and Rebecca
Whiteside, South Central; Amy Ford-Hulen, Tamara Bonds, Amelia Carlson, Mary Beth Duke,
Kimberley Smith, and Shemeka Worles, Southwest; Elaine Hong and Mary Rivers, Tennessee
Valley; and Carla Forsyth and Denice Whittaker, Upper Cumberland. Additional support for the
organization and coordination of the regional reviews was provided from QSR liaisons to the
regions: Sherry Haines and Doretha Johnson with the Tennessee Center for Child Welfare
(TCCW) and Frank Mix and Bethany Womack with the Department.
Quality Assurance-Technical Assistance during the review was provided by Steve Chester,
Frances Lewis, and Pat Wade from the Tennessee Commission on Children and Youth (TCCY);
Sherry Haines, Doretha Johnson, and Landra Orr with TCCW; and Stephanie Coleman, Chris
Griffy, Rebecca Hendrich, Susan Mee, Frank Mix, and Bethany Womack with the Department.
Workgroups and contributors for specific topics include: Dave Aguzzi, Diane Irwin, Beth Kasch,
Lisa Lund, Kim Mallory, Barbara Maners, Jackie Moore, Connie Murphy, Tony Nease, Linda
O’Neal, Pat Wade and Kelly Whitfield. Many thanks also to Carla Aaron, John Johnson, Andy
Shookhoff and Sandra Wilson for supporting their participation.
Thanks also to the reviewers – this year, 220 reviewers participated in reviewing 355 cases,
completing a total of over 2700 interviews. The reviewer pool consists of regional and Central
Office Department staff from a variety of program areas, Tennessee Commission on Children
and Youth CPORT staff and Commission Members from different areas of the state, and Social
Work Practice Specialists and University Consortium Trainers from the Tennessee Center for
Child Welfare. This year, we were also joined by CASA and Juvenile Court Staff from
Davidson County. A list of participating reviewers can be found in Appendix F.
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Table of Contents
Executive Summary
3
Strengths, Opportunities, System Issues and Next Steps
10
Discussion of Data and Charts
16
Non-custodial Cases
22
Permanence
Permanency Goals
Placement Type
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27
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Recruitment and Retention
40
Youth
41
Juvenile Justice
43
Court and Legal System
47
Appendix A – Review Process
50
Appendix B – Brian A. Charts
52
Appendix C – Severe Abuse Targeted Analysis
55
Appendix D – Regional QSR results
58
Appendix E – Critical Issues of the Custodial Population
70
Appendix F – List of Participating Reviewers
73
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Tennessee Quality Service Review (QSR) Results
2010-2011
Executive Summary
3
Executive Summary
Since 2005, the Tennessee QSR Team, comprised of staff from the Department of Children’s
Services (DCS), Tennessee Commission on Children and Youth (TCCY) and the Tennessee
Center for Child Welfare (TCCW) have worked collaboratively to conduct a comprehensive
case-based quality services review (QSR) process. The process involves a comprehensive
evaluation of service delivery outcomes by examining relevant aspects of the lives of children
and families being served by DCS. The ultimate goal of QSR is to promote positive change by
providing qualitative and quantitative information about the status of the child/family and service
system function for the cases reviewed. QSR results can be used for continuous system
improvement and implementation and reinforcement of best practices for children and their
families.
The reviews are conducted in each of the state’s 12 DCS regions on a stratified random sample
of children in state custody sufficient to provide validity at the 99 percent level statewide and the
85 percent level regionally. In addition, two or three non-custody cases per region were selected
for review from the DCS multiple response system (MRS) assessment track. A targeted review
of children residing in Youth Development Centers was also completed, and information from
this review is also included in this summary.
For each case reviewed, the review team produced a narrative summary after the review was
completed. The narrative summary provides a description of the findings, explaining the
reviewer’s perspective about what seems to be working and what needs improvement. The
narratives help explain the numerical results of the review by describing the circumstances of
each case.
The QSR process includes a review of records for the following items:
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Psychological or other specialized evaluations;
School records and Individual Education Plan(s), if applicable;
Service Plan(s) or Individual Program Plan.
Court order for custody;
Family Functional Assessment;
Petition that led to custody;
Family Functional Assessment;
The majority of information is collected through structured interviews with the following:
Child, if age appropriate;
Parent(s);
Caregiver (resource parent or direct care staff in a facility);
Family service work or case manager;
Teacher or other school representative;
Any other relevant service provider (Guardian ad Litem, therapist, etc.);
Other significant/relevant person (relative, friend, coach, etc.).
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Before writing the brief narrative case summary of the case, certified reviewers apply the
pertinent information collected through the in-depth interview process to specific criterion
measures or indicators regarding the status of child and family and the adequacy of the service
system functioning
Significant Achievements:
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Practice across Brian A. cases continues to improve, as do Safety, Permanency, and
Well-being measures. (See Appendix B)
The percentage of ratings in the Poor or Adverse and Substantially Unacceptable
range has steadily declined on both Child and Family Status and System Performance
indicators, while the percentage of ratings in the Acceptable range is increasing (See
charts on page 21).
Practice with youth has improved significantly over the past year, with the percentage
of cases rating acceptably for youth age 14 and older exceeding the statewide average
on most indicators. This reverses a trend seen in previous review years. (See
“Youth” beginning on page 41).
The practice observed in Juvenile Justice cases is consistent with that seen in Brian A.
cases. Family-centered practice is being effectively implemented in an everincreasing proportion of juvenile justice cases where youth are placed in community
settings; however, family-centered practice with youth placed in hardware-secure
Youth Development Centers is not as consistent.(See “Juvenile Justice” beginning on
page 43)
In non-custodial casework, early Engagement, teambuilding, and Assessment were
linked to positive outcomes, as they are in custodial cases. In some cases, the referral
that opened the case was “unfounded,” but the family and worker were able to
identify areas that a team could support to enhance long-term safety and well-being.
In others, the families and the Department could not clearly articulate how DCS
involvement would enhance Safety and Well-being; when these cases were not
promptly closed families reported DCS involvement felt intrusive rather than
supportive. (See “Non-custodial” beginning on page 22).
QSR Findings: Status of the Child and Family in Custodial Cases Reviewed
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Child safety was maintained at a high level, with almost all children safe from harm
(98%).
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The physical well-being of the great majority of children was adequately addressed at
the time of review (99%).
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Caregivers were adequately meeting children’s needs (95%).
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Most or many children were making progress in education or a vocation (83%), also
the highest level achieved to date.
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The emotional well-being of most children in custody was adequately addressed
(81%), the highest percentage achieved to date.
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Permanency and Family Functioning are indicators that are linked heavily to System
Performance. These continue to improve.
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An indicator that could benefit from continued support is Family Connections (57%).
QSR Findings: Service System Performance/Functions in Custodial Cases Reviewed
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The system was engaging most children, if age appropriate, and their families in the
planning and implementation of services (61%).
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There was an adequate assessment of child and family needs in 50% of cases.
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Conditions and attributes of practice that, as they improve, support best practice
outcomes, include Resource Availability (71%), Informal Supports (62%), Placement
Supports (93%) and Transitioning (49%).
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In many cases the system adequately identified the long-term view for ensuring
Safety, Permanency and Well-being beyond system involvement (42%), the highest
level achieved on this indicator to date.
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Despite improvements, Long-term View and Transitioning are areas that could
benefit from more attention.
System Recommendations
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Develop a coordinated system of care network involving the Departments of Children’s
Services, Education, Health, Human Services, Mental Health, and Developmental and
Intellectual Disabilities at the state level, and with an array of public and private
organizations, including courts, schools, child advocates and community organizations at
the local/community level. These community partnerships are essential to prevent
children from unnecessarily entering state custody, access needed mental health,
substance abuse, and health services, link children and families to needed public
assistance, access transition to adult service systems, and successfully implement Child
and Family Team Meetings.
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Continue to improve frontline supervision to support staff in implementing best practice.
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Utilize the Quality Practice Teams to not just identify and address areas for improvement,
but to also share experiences and successful strategies across regions and partner agencies
to improve the implementation of best practice.
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Continue to implement the Child and Family Team (CFTM) approach to serving children
and families. Ensure all knowledgeable and relevant team participants are included in the
Child and Family Team meetings to support optimal decision-making practices.
Additionally, ensure team decisions are advocated in court.
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Continue implementing strategies that support ongoing functional assessment processes
to identify strengths and needs of the child/family and make changes as necessary.
Family Service Workers need access to Child Protective Services records and/or other
previous intervention or prevention efforts for decision-making and planning strategic
service delivery. Continue to develop caseworkers’ skills in practical casework and
family system dynamics. Ensure family service workers (FSW) are fully trained and
practice family-centered case planning that encourages, respects and incorporates input
from the children and families it serves.
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Improve coordination and communication between the Child and Family Team and DCS
legal staff for improved outcomes for children and families.
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Ensure children and their families receive timely evidence-based, best practice, culturally
competent quality mental health services with attention to child/family resiliency,
recovery and treatment.
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Ensure adequate and appropriate independent living/transition services are provided to
children aging out of foster care, including those adjudicated delinquent.
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Partner with DCS Legal and local court staff to support the Child and Family Team
decision-making process, even in cases where a Severe Abuse adjudication is being
sought or criminal charges are being pursued and when no-contact orders are present.
Barriers to communication and work with families during criminal investigations and
delays in adjudication negatively impact outcomes for children.
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Early engagement and teambuilding during the CPS and assessment work was associated
with positive outcomes when that Child and Family Team is the primary decision-maker.
Continuing strategies to support early work will likely help improve best practice
outcomes in non-custodial cases and reduce the number of children entering custody.
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Encourage frequent contact and partnership between Family Service Workers and the
Case Managers in the Youth Development Centers to support implementation of best
practice for youth in the facilities.
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Improve advocacy for all children by ensuring that fundamental due process rights for
children and families are met and that parties have adequate and effective representation.
Opportunities exist with both Guardians ad litem and with attorneys representing parents.
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Improve the overall internal communication between DCS Central Office program and
DCS field staff to ensure overall goals of DCS are articulated clearly and provide support
to regional efforts towards implementing best practice.
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Continue to implement and support a qualitative case review process to provide a
mechanism to identify opportunities to strengthen practice and overall system
functioning.
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Training Recommendations
To enable staff to adequately serve children and families, provide detailed and specialized
training for development of skills needed to implement job responsibilities.
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Field staff express a desire to have more information regarding specialty areas related to
transition services from the child-serving system to the adult-serving system, special
education, mental health and substance abuse/addiction, and in some cases understand
how to access Well-being units as a means to secure appropriate services. In addition,
workers express a need for the practical knowledge in order to implement these
processes, such as collecting necessary information and documentation.
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Provide coaching and mentoring to Team Leaders and Team Coordinators around using
principles of best practice at the supervisory level to enhance their teams’ ability to
implement best practice principles. Continue to support training initiatives for
supervisors to adequately develop leadership and skills necessary to support frontline
staff in best practice principles.
Recommendations for Additional Resources
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Provide adequate placement resources for appropriate out-of-home placements in a
timely manner as close to home as possible, preferably within the child’s home
community. Distance to placement is a challenge to communication, maintaining family
connections and can result in delays in achieving permanency.
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Frequent contact between team members and visits between family members and Family
Service Workers is associated with positive outcomes. Ensure resources are available to
support frequent visits, such as transportation and financial support for travel.
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Encourage continuum providers to adopt the practice of utilizing placements closer to the
child’s home community.
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Provide adequate placement resources for step-down for youth exiting residential
treatment or YDC placements.
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For expedited placements, once the PATH process is completed ensure board payments
begin timely.
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Improve the recruitment and retention of staff. Review the current administrative
requirements that create barriers to frontline practice and lead to case worker turnover.
The following information summarizes findings for the cases selected as part of the CPORT
Statewide Sample, reporting on factors present in cases from a sample representative of the
custodial population statewide. More Critical Issues impacting children in state custody may be
found in Appendix E:
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Demographic Information
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For the 79% of families whose household income is known, 64% had incomes of less
than $24,999, near or below poverty for a family of four ($22,350), and a notable number
had incomes reported at less than $5000.
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Twenty-six percent of children were from single-parent, mother head of household
families; 23% from families with both birth parents; and 16% from relatives (not
biological parents). Other family types include those with step-parents, adoptive parents,
and single-parent, father head of household.
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Children exhibiting behavior problems (26%) and neglect by caregiver (25%) were the
main reasons for children to enter custody.
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The largest age group of children in care was age 14 and older (44%).
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The majority of children were Caucasian (63%).
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The majority of children in custody were male (59%).
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The average length of stay for all cases reviewed was 1.3 years.
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Tennessee Quality Service Review (QSR) Results
2010-2011
In 2010-2011, the Department of Children’s Services, Tennessee Commission on Children and
Youth and the Tennessee Center for Child Welfare worked collaboratively to conduct a
comprehensive case-based quality services review (QSR) process. This process provides a way
of knowing what is working/not working in practice and why for selected children and families
receiving services. A stratified random sample of cases from each of the 12 DCS regions were
reviewed to determine how well the system is performing to meet the needs of the children and
families served. The purposes of QSR are to provide a tool that promotes overall quality
improvement in providing services to children and families, to answer questions regarding
current practice and to stimulate change and instill principles of good practice. Meeting the
many needs of children and their families is challenging. The QSR results provide information
that assists key stakeholders, policy makers and legislators to make informed decisions, and
significantly influence the steps needed to maintain or enhance and improve services to children
and their families in Tennessee.
The following information summarizes the status of children and the performance of the service
delivery system as it continues to evolve in Tennessee.
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Strengths
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A number of regions had great success with supporting positive relationships between birth
parents and resource parents. Shelby, Knox, Davidson and South Central regions had
multiple cases where this positive teamwork was present. Resource parents were very active
participants in the Child and Family Teams and understood their role as supporting the birth
parents through the change process to allow for reunification. In Davidson County, this has
been a trend over the past two years of review. In Davidson, resource parents seemed to
identify their role as one of working with the whole family; in South Central, the resource
parents were willing (and expecting) to be ongoing informal supports to the youth and
family. In Knox and Davidson, cases were moving smoothly to adoption, supported by the
trust built between birth and resource families.
Family members, service providers, and FSWs in cases with successful Teamwork and
Coordination nearly always cited “frequent communication” as a factor in casework moving
forward. Strategies for accomplishing this included rapidly returning phone calls by FSWs
and in a few cases, regularly scheduled meetings. The use of facilitators is generally
prioritized for permanency planning meetings or in cases where there are differences in
opinion among team members about case planning direction, and the presence of facilitators
was generally seen as a positive attribute about these meetings. Some FSWs or agency
workers would check in with parents a few days after a meeting, just to make sure decisions
were understood or to follow up on any questions. The use of interpreters was very
meaningful to families; in one case the parent spoke passable English but was more at ease in
the teaming process when an interpreter for his native language was present. When family
members were most satisfied with services and supports from the Department, they related
this to the frequency and quality of the communication with their FSW. In a few cases, birth
parents who were unlikely to achieve successful reunification nevertheless reported being
satisfied with supports and services when they believed their FSW was sharing information
with them honestly.
Another element of Teamwork occurs outside of the individual family cases and
encompasses the degree to which internal DCS staff team with each other. In Tennessee
Valley’s review, the positive working relationship between FSWs and the YDC case
managers was very apparent in the cases of youth placed in those facilities. In these cases,
there were few barriers presented to face-to-face visitation between FSWs, parents, and youth
– travel and transportation issues were able to be addressed by the team. Taft and New
Visions YDCs were flexible about their internal meeting schedule to meet the needs of the
families and home county workers, supporting Family Connections and Long-Term View
from the beginning of cases. Internal teamwork between Education Specialists and Regional
Psychologists was also a strength in several cases, with this contributing to positive outcomes
in Ongoing Functional Assessment and Well-being indicators as well as Teamwork.
Teambuilding early on in cases, including during any non-custodial casework prior to
children entering custody, tended to have a lasting positive impact on family involvement
and team functioning as cases progressed. Upper Cumberland achieved very strong ratings
on Family Connections. Much of the success came from locating and utilizing paternal
extended family in teaming, and diligent searches were conducted with a goal of identifying
extended family and engaging them in the teaming process. When diligent searches were
conducted early on in the life of a case, Shelby also had much success in identifying fathers
and extended paternal relatives and supporting their involvement in the Child and Family
Teams. In several of the non-custodial cases, teambuilding early in the assessment process
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helped families overcome initial resistance to DCS involvement. Genuineness extending to
trusted family supports seems to decrease the “intimidation factor” surrounding DCS
involvement.
It appears that transitioning is, for an increasing proportion of Child and Family Teams, a
proactive rather than a reactive process. Many different types of transitions occur in cases.
Children and youth experience age-appropriate transitions across school settings and in the
types of activities they participate in, and each case also transitions into and out of service
involvement. Some families and children experience service provider changes, FSW
changes, and placement changes, and these can be planned or unplanned. When changes
occurred, cases with strong teams with members who frequently communicate were able to
mitigate any problems that might arise when team membership changes. Additionally,
planning for transitions between placements and transitions home were managed well in a
number of cases, with resource parent involvement in preparing children for moves also
contributing to positive outcomes. East and South Central had a lot of success with
Transitioning in cases where Informal Supports were utilized in Child and Family Teams. In
South Central, a transitioning exercise used with staff seems to have produced very good
results in this area. Supervisors and FSWs physically wrote out the “transition plan” for their
families; this specific focus on transitioning out of custody/services helped them identify
unanswered questions the team could consider as the cases moved forward.
Strong family-centered practice was evident in cases of youth adjudicated delinquent,
particularly in Southwest, South Central, Tennessee Valley, and Smoky Mountain. This has
been a standout area of Southwest’s practice for the past 3 or 4 years, so it appears they have
built some strategies within the region, with their providers, and with the Youth
Development Center partners to sustain the family-centered approach in Juvenile Justice
cases.
Work with youth showed many positive results this year. For the first year since QSR began,
practice outcomes achieved for youth were above the average of cases of children of all ages.
Several strategies have been put into place to strengthen Independent Living programs.
Another reason may relate to strategies such as FOCUS (an intensive and individualized
recruitment process) and archaeological digs (a strategy to identify people with a previous
relationship to a child) to help increase the likelihood of finding Permanency resources for
teens and older youth.
Burgeoning partnerships with private agency providers in the QSR process have the potential
to support positive results by increasing partnership and communication around best practice
expectations. Upper Cumberland and Mid-Cumberland had a lot of success in involving
providers in their QSR process. Provider representation was present in the preparation
workshop, in some of the feedback sessions with the FSW & TL, and at their Friday wrapup. Additionally, East and Knox regions have utilized private agency partners in their miniQSR processes.
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Opportunities for Improvement
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While Teamwork is showing improvement in a statewide look at the population, there were
some opportunities to strengthen Teamwork. Generally, the cases that seemed to have the
most challenges in forming a cohesive team experiencing frequent communication tended to
involve cases with children or youth placed in congregate care, including residential treatment
centers and YDCs. In several cases, simply the distance to placement is a challenge to
communication. Another common thread among these cases is that they tended to have the
lowest percentage of cases with acceptable Informal Supports. This suggests a chicken-andegg pattern: while it may be that problems with forming and coordinating a team may mean
informal supports are not identified, it could also be that a lack of informal supports input into
a team may be limiting the teams’ effectiveness. In either case, the involvement of Informal
Supports nearly always contributed to something positive in Teaming. Stability in these cases
is also very challenged (46% acceptable compared with 73% acceptable among children and
youth placed in family settings). Generally, youth in these placements have had several
moves related to behavior problems – for Brian A. youth, placement in a congregate facility
often occurs after disruptions in placements at lower levels of care. This results in turnover in
team membership, which without a well-coordinated point of contact within the team can also
contribute to challenges in effective Teamwork.
Resource Availability and Use is increasing statewide. As we get better at implementing
family-centered practice across a wide spectrum of case practice, resources available to
parents to support stability and permanency are being identified more consistently. However,
there are still examples of cases where teams have to creatively address challenges presented
when services are located outside a practical travel area for families. Appropriateness of
Placement was an issue for seven of the twenty cases of youth placed in congregate care who
are members of the Brian A. class. For four of the youth, teams were looking for but had been
unable to locate a suitable step down resource home for the youth at the time of the review.
For two youth, the placements were meeting their level of care but were so far away from
their home communities they had lost connections to remaining informal supports.
Effective implementation of a family-centered practice model requires teams to have the
ability to individualize services and planning based on the strengths and needs of the family.
In some cases, we appear to be confounding our own efforts to individualize services by
relying heavily on adherence to processes that are not relevant to, or achieving, desired
outcomes for children and families. In a few cases, relatives who might not be eligible to be
an expedited placement or be approved for Interstate Child Placement Compact (ICPC) were
not utilized as supports even though their participation in planning would not pose safety
risks. Some teams believed that adoption discussions could occur only after TPR,
confounding efforts at concurrent planning.
Challenges in court-involved cases were seen when the Child and Family Team and DCS
legal were not well-coordinated. In some cases, teams were not clear about what information
the DCS attorney needed from them to complete a petition, requiring some time spent revising
petitions. Individual courts have different procedures for setting dockets and preferences
about the presentation of petitions. In a number of cases, attorneys were participating on
Child and Family Teams. While this is generally encouraged, in a few cases they were
participating in such a manner that other team members were discouraged from sharing their
thoughts. There has been much emphasis in the past few years on timely TPRs, for which
legal staff are critical, but there are other opportunities to recognize the contribution DCS
attorneys make in supporting best practice and advocating for other outcomes as well.
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Systemic Issues
In each case, there are opportunities to identify conditions of the child welfare system that
influence practice. Specific cases are discussed in more detail throughout the summary. Key
issues identified over the 2010-2011 school year include:
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There is limited availability for step-down placements for youth exiting residential
treatment or YDC placements. For youth placed through continuums, in situations where
step-downs are not available at the time of discharge, it appears that a certain period of
time is allowed to elapse before teams consider seeking resources through another
agency. The closure of the DCS Group Homes this year impacted a few cases; most
notably those of youth adjudicated delinquent who were eighteen years of age. Because
residential treatment programs that serve youth are not licensed to take adults (age 18 in
that system), their only option for treatment placements is a Youth Development Center.
TFACTS, the new SACWIS system, rolled out statewide in August of 2010. This system
is designed to capture family-centered practice by organizing data by family rather than
by person. Included in the roll-out strategy were discussions and trainings around using
the new system. Report production is an area of ongoing development within TFACTS,
for the field the new system produced some challenges as people adjusted to the new
system. For a short time, one judge refused to sign Permanency Plans because of serious
formatting issues with the new system’s production. Major issues have been and
continue to be addressed through rebuilds. During this period covered by this statewide
review, Department and Private Agency staff have been adjusting to using a new system
while administrative and managerial staff are challenged by a wait to complete the
production of reports that were available prior to the roll out.
Regional feedback about the quality of casework done by stipend students was
overwhelmingly positive. It was felt that the casework of participants in the program or
recent graduates was strong and reflective of best practice outcomes, and that the
educational program the students are receiving is highly consistent with best practice.
A systemic issue that impacts every partner in the child welfare system related to
financial resources. For the past few years the Department and other partners in the child
welfare system have been trimming their budgets or responding to a reduction in
resources. At the same time, it seems that more families are experiencing reductions in
their own household resources.
In some cases, the courts serve as primary decision-makers rather than the Child and
Family Team. When this occurs, practice outcomes are poor – but then, child welfare
practice is not driving the case. In some cases, this indicates a practice opportunity as
courts step in as decision-makers when this function is not evident from the team; in
others, cases become more about custody decisions between family members than in
effecting change to improve functioning within a family. In others, cases get “stuck” in
court when the team begins to see achieving TPR as the goal they are focusing on, rather
than achieving TPR as a step in accomplishing a well-defined permanency plan.
The Family Functional Assessment tool was designed to facilitate the ongoing recording
of family assessment information, but it is generally regarded as unwieldy and no more
conducive to quality assessment than other tools. A workgroup of Central Office and
Regional staff are looking at this to identify ways this may be improved.
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Next Steps and Recommendations
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To help ensure that conditions conducive to positive outcomes are present, it may be
worth looking at ways to shorten the expedited approval process and to consider the
effectiveness of visits in overall practice when looking at budget and fiscal issues.
Frequency of contact between FSWs, families, and children was cited in many cases as a
major strength in Teamwork, and Family Connections was very important to
reunification. Also, there were some examples of relative caregivers experiencing
financial hardship and spending down their savings in order to bridge the gap between the
date of their relatives being placed with them and receiving a board payment.
Initial feedback about the Quality Practice Team (QPT) process has been positive. The
organization of the teams makes it easier to identify the group that can most effectively
address a particular issue. Continuing to use the QPT process and the field focus group
both to identify areas for improvement, share experiences across regions, and identify
working groups to develop potential solutions should assist Central Office program staff
and regional staff in addressing barriers to best practice and supporting the strategies in
place that are working.
This year, the QSR process has seen an increase in the involvement of providers in
sessions addressing QSR preparation and in the wrap-up sessions held on Fridays
following the reviews. In the 2011-2012 review cycle, DCS is offering training credit for
provider agency staff who participate in the reviews as shadows. The addition of focus
groups to the QSR process will also help increase the opportunities for direct feedback
about the child welfare system.
No-contact orders are sometimes used in cases where a parent’s or sibling’s behavior
might pose a safety risk or contact would be detrimental in some way to the children. If
these are in place, the team should also be mindful that this is ineffective as a “status
quo” measure. To avoid situations where no-contact orders become a barrier, teams
would benefit from developing a means to assess the continued utility of these orders.
In non-custodial cases, early engagement and teambuilding during the investigation or
assessment phase helped support best practice during the ongoing work of the case,
especially when informal supports are used in the assessment process and in identifying
resources. Continuing strategies to support this early work will likely help improve best
practice outcomes in non-custodial cases.
There are opportunities to identify desired outcomes in non-custodial cases, as some of
the cases were open longer than appeared necessary. Neither the families nor the
Department could articulate a role for DCS in supporting Safety or Well-being.
Including Central Intake in conversations about non-custodial casework will likely help
identify opportunities to strengthen the Department’s gate-keeping processes.
Across all types of cases, frequent contact between FSWs, families, and children is
associated with positive outcomes. Distance and cost of travel is a consideration for all
workers when travel to visits is required. However, regions seem to have different
resources available to support family visitation. Likewise, it appears that in some regions
FSWs face restrictions on travel that put a damper on the frequency of contact with
children and families – and the development of a helping relationship. In the same way,
encouraging frequent contact between FSWs and YDC case managers, youth, and family
members should also support best practice.
15
Discussion of Data and Charts
During the 2010-2011 review year 309 cases were reviewed during the statewide review cycle,
with cases selected from the regional population, and 46 cases were reviewed during the
summertime Youth Development Center targeted reviews, with a sample pulled from the YDC
population. Over twenty-seven hundred interviews with key stakeholders including children,
youth, and family members, resource parents, service providers, FSWs and agency staff,
teachers, GALs and CASA volunteers, and other significant case members were conducted by
two-person teams, with respondents providing information about their experience as providers of
or recipients of services and supports from DCS and partner agencies, court systems, school
systems, and healthcare systems. For each case reviewed, the reviewers assessed outcomes for
each case through a series of 22 indicators - 11 child status indicators and 11 practice
performance indicators. A six-point rating scale was used by reviewers to assess the status of
outcomes for each indicator. The range of ratings is as follows:
1.
2.
3.
4.
5.
6.
Adverse status/performance, completely unacceptable
Poor status/performance, substantially unacceptable
Marginal status/performance, minimally unacceptable
Fair status/performance, minimally acceptable
Good status/performance, substantially acceptable
Optimal status/performance
In each of the regional reviews, twenty-two cases were selected through a stratified random
sampling process of custodial cases. Three non-custodial cases were selected for review with
regions selecting three cases from a randomly-selected list provided by Central Office. In the
YDC reviews held over the summer, six cases from New Visions and ten cases each from
Mountain View, Taft, Wilder, and Woodland Hills were selected at random.
As the following charts show, there has been very encouraging progress toward achieving
desired outcomes. Over the past four years, every indicator has shown improvement, and many
of the indicators have shown noticeable improvement between last year and this year. The
indicators that directly capture how well we are implementing our Family-Centered Practice
Model Principles (the “Practice Wheel”) have all shown improvement over the last four years, as
have the Child and Family Status Indicators of Permanency and Family Functioning.
Improvements in our work – that is, the System Performance indicators, are validated by the
improvements we are seeing in our work product – that is, the Child and Family Status
indicators.
In the Child and Family Status domain, indicators speak to a “snapshot” of how a child and
family are doing in the 30 days most recent to the review. Safety has been an area of strength
within the custodial population, as has Appropriateness of Placement and Caregiver Functioning.
Still, within the past four years there has been a general trend toward improvement in these areas
as well. System Performance data, which speaks to a dominant pattern of practice over the last
90 days, may point to possible reasons why these areas remain strong. Some trends noted in the
case stories that seem to play a role in these Status outcomes include caregiver participation in
Child and Family Teaming, a family-centered focus on Assessment, positive Family Functioning
and Family Connections, and Placement Supports – all of which can speak to the quality and
16
safety of visits as well as an increasing awareness among resource parents around their value as a
Child and Family Team member.
Well-being indicators, including Health and Physical Well-being, Emotional/Behavioral Wellbeing, and Learning and Development, have also shown an increase in the percentage of children
and youth rating acceptably. Case stories speak to the involvement of Education Specialists,
Independent Living Specialists and Regional Psychologists either acting as Child and Family
Team participants or consultants to FSWs. Additionally, the Centers of Excellence are generally
seen as a very helpful resource for teams working to support children and families with
significant challenges. The Department identified an opportunity to strengthen practice by
improving the use of these and other formal assessments in the planning process. Strategies to
assist field staff were put into place, such as Assessment Integration Training and the utilization
of the Social Work Practice Specialists and Regional Psychologists. Tools such as the Child and
Adolescent Needs and Strengths and the Youth Level of Service (CANS and YLS) were
implemented as well, with technical assistance resources in place to help ensure the information
captured in the tools could be applied meaningfully. Improvements in QSR ratings on
Assessment and Understanding and Child and Family Planning Process are based not just on use
of the tools (which can be captured through other measurements), but on the quality of their
application. An encouraging rate of improvement was noted this year in both of those measures;
additionally, ratings on Ongoing Functional Assessment1 were strongly correlated with ratings
on the Child and Family Planning Process – suggesting that teams are integrating assessment
information into plans.
The Child and Family Planning Process indicator has also shown a great deal of improvement in
the last year. Cases that demonstrated an effective Planning Process typically demonstrated
effective Teamwork as well. This was particularly supported by teambuilding early in cases,
identifying family’s natural informal support network and utilizing their knowledge in
assessment and resources in planning. For youth, the Planning Process greatly benefitted when
the team could look beyond short-term needs and work with the youth toward long-term goals.
During the 2010-2011 review year, the demonstration of best practice was noted in the majority
of cases involving youth, and youth in turn make up the largest age group among the custodial
population. This reverses a trend noted in previous years of review.
The charts used in this summary reflect, except where noted, all custodial cases reviewed during
the 2010-2011 review cycle. This includes Brian A. and Juvenile Justice cases. When data is
broken out across different groups within the reviewed cases, striped columns are included for
ease of comparison between subsets and the average across the review population.
1
The QSR uses similar language to describe the indicator capturing assessment as the Department uses to describe
the primary tool used to capture ongoing historical and current assessment information. The tool used, the Family
Functional Assessment, may inform the Ongoing Functional Assessment QSR indicator, but it is important to
understand they are distinct from and not solely dependent upon each other.
17
2007-2008 n=243
2008-2009 n=243
2009-2010 n=253
2010-2011 n=256
41%
48%
52%
57%
Le
ar
ar
eg
ni
iv
ng
er
Fu
nc
tio
Fa
ni
m
ng
ily
Fu
nc
Fa
tio
m
ni
ng
ily
C
on
ne
ct
io
ns
Sa
tis
fa
ct
io
n
C
Be
ha
vi
or
al
ea
lth
H
ot
io
na
l/
Em
en
cy
Pe
rm
an
en
t
Pl
ac
em
St
ab
ilit
y
Ap
pr
op
ria
te
Sa
fe
ty
17%
17%
26%
35%
28%
34%
41%
47%
72%
74%
79%
80%
89%
94%
93%
95%
71%
72%
78%
81%
68%
67%
52%
58%
74%
78%
78%
83%
98%
98%
98%
99%
86%
86%
91%
89%
94%
96%
98%
98%
Child and Family Percent Acceptable
Custodial Cases
The chart above shows the percentage of cases rating acceptably (4, 5, or 6) by indicator. Cases shown here are custodial cases, including children and youth
adjudicated Dependent/Neglected, Unruly, and Delinquent. Non-custodial cases were not reviewed in the 2007-2008 or 2008-2009 review years. Noncustodial cases are discussed on page 12. An additional 46 cases were reviewed in the summer of 2011 in a targeted review of youth placed in the five YDCs.
Information about those cases begins on page 32.
18
82%
91%
35%
45%
49%
46%
50%
62%
64%
71%
59%
58%
54%
35%
37%
41%
52%
41%
30%
35%
36%
29%
35%
42%
33%
27%
29%
29%
36%
40%
50%
54%
59%
47%
43%
30%
C
As
se
ss
m
Te
am
wo
rk
an
d
En
ga
ge
m
en
t
oo
en
rd
in
t&
at
io
Un
n
de
rs
ta
nd
Lo
in
ng
g
-T
er
m
Pl
Vi
an
ew
ni
ng
Pl
Pr
an
oc
es
Im
s
pl
em
Tr
ac
en
ki
ta
ng
tio
&
n
Ad
R
ju
es
st
m
ou
en
rc
t
e
Av
ai
la
In
bi
fo
lit
rm
y
al
Su
Pl
pp
ac
em
or
ts
en
tS
up
po
rts
Tr
an
si
tio
ni
ng
45%
38%
46%
61%
2009-2010 n=253
2010-2011 n=256
89%
93%
System Performance Percent Acceptable
Custodial Cases
2008-2009 n=243
31%
31%
2007-2008 n=243
The chart above shows the percentage of cases rating acceptably (4, 5, or 6) by indicator. Cases shown here are custodial cases, including children and youth
19
adjudicated Dependent/Neglected, Unruly, and Delinquent. Non-custodial cases were not reviewed in the 2007-2008 or 2008-2009 review years. Non-custodial
cases are discussed on page 12. An additional 46 cases were reviewed in the summer of 2011 in a targeted review of youth placed in the five YDCs. Information
about those cases begins on page 32.
Trending of Marginal Cases
The following charts show the percentage of indicators in each domain for custodial children
reviewed (Child & Family Status and System Performance) with findings in the acceptable
(4,5,6), marginally unacceptable (3), and poor or adverse (1,2) range and compare this year’s
data with data from earlier statewide review cycles2. One advantage of looking at the data this
way is that it captures the percentage of ratings falling in the “marginal range,” that is, situations
that are not currently acceptable although elements of practice may be present or, for Child and
Family indicators, status may be mixed but risks of harm are minimal. Indicators rating a “3” are
considered to be unacceptable in the short term, but refinement would bring it reasonably quickly
into the acceptable range. Capturing cases in this range over time informs the system about what
proportion of cases could become acceptable with minor adjustments to practice or system
supports and minor improvements in status. If, over time, the percentage of cases rating a “3”
decrease or remain fairly stable (as has occurred in the Child and Family Status domain) along
with increases in the percentage of cases rating acceptably and decreases in the percentage of
cases rating a “2” or “1,” this suggests the system is improving its ability to consistently support
good outcomes in a variety of cases. If the percentage of cases rating a “3” increases in relation
to cases rating acceptably or a “2” or a “1,” (as occurred on the System Performance domain
between 2005-2006 and 2007-2008), that would suggest that practice is improving but not to the
desired degree. That pattern would not be unexpected during early years of system reform, and
since that time the percentage of cases rating acceptably on System Performance indicators has
trended consistently upward, with a rather large increase between the last year’s review and this
year’s. Concurrent with those improvements, acceptable ratings on Child and Family Status
indicators have also consistently moved upward since the first year of review while “poor” or
“adverse” ratings have declined to under 10%. While slightly over one quarter of our cases still
fall into the “refinement” category on System Performance indicators, in 86% of the cases at
least some elements of practice are noted with the majority of cases falling into the acceptable
range.
2
Statewide reviews were completed during 2006-2007; however, quality assurance procedures were still developing
at that time. In several regions, ratings tended to be quite high without a clear practice or system change-based
reason. While information from the case stories and summaries is valuable within context, we do not feel the data
quality from that year is useful for comparative purposes.
20
Statewide Child and Family Status - Custodial Cases
76.4%
73.4%
69.7%
67.4%
65.4%
Percent of Scores Within Each Range
2005-2006
2007-2008
2008-2009
2009-2010
Acceptable (Score of 4,5,6)
Marginally Unacceptable (Score of 3)
8.0%
10.3%
13.0%
14.5%
17.3%
15.6%
16.3%
17.3%
18.1%
17.3%
2010-2011
Poor or Adverse (Score of 1,2)
Statewide System Performance - Custodial Cases
2005-2006
2007-2008
46.5%
Acceptable (Score of 4,5,6)
2008-2009
Marginally Unacceptable (Score of 3)
14.0%
23.1%
22.2%
2010-2011
26.7%
31.6%
27.6%
30.4%
33.7%
34.0%
2009-2010
31.1%
44.1%
39.3%
37.3%
58.4%
Percent of Scores Within Each Range
Poor or Adverse (Score of 1,2)
The above charts represent custodial children reviewed in the past 5 review cycles for which data could be obtained.
21
Non-Custodial Cases
During the 2009-2010 review year, the Department piloted using the QSR tool to review noncustodial cases. In 2010-2011, non-custodial cases were reviewed with a semi-random sample.
Sampling procedures were complicated by the lack of available reports distinguishing cases that
met criteria for review from cases that did not. Consequently, regional feedback and selection
among a group of cases was needed in order to identify three cases for review. Cases met
criteria for review if they were consistent with one of the following:
•
•
•
•
An investigation that has been classified and transferred to an FSW, with the FSW having
had the case at least 30 days
An assessment-track case transferred to an FSW, with the FSW having had the case at least
30 days
An open case in the assessment track at least 60 days old
An in-home case assigned to an FSW at least 30 days old that was generated due to court
involvement.
The QSR tool is designed to capture the outcomes present within cases, rather than relying solely
on the activities occurring within a case. In order to effectively use the QSR tool, cases should
be open a period of time long enough where one can identify what actions have been taken in the
case and the results. Generally, non-custodial interventions are shorter in duration than in the
custodial cases measured in QSR (the shortest-term custodial cases, such as those where children
exit custody at the preliminary hearing, are excluded from review), hence the timeframes
established for the non-custodial cases. The indicators in the QSR protocol were found to be
relevant as written to the non-custodial cases, although some minor adjustments to language
describing written plans, team meetings, and assessment tools were made in the 2011-2012
protocol to be more inclusive of non-custodial terminology.
The charts used in this section show the percentage of non-custodial cases rating acceptably (4,
5, or 6) by indicator. Non-custodial cases were not reviewed in the 2007-2008 or 2008-2009
review years, and a non-random sample was piloted during the 09-10 review year. Therefore,
comparative data for prior years is not available. The shaded bar representing custodial ratings
achieved in the 2010-2011 review years are included as a comparative point of reference.
22
2010-2011 All custodial cases n=256
90%
ac
tio
n
isf
ns
Sa
t
ct
io
on
ne
ni
ng
ct
io
Fa
m
ily
Fu
n
C
ng
ni
ily
Fa
m
ar
e
gi
ve
r
Fu
n
ct
io
ar
n
in
g
l
Le
C
av
io
ra
na
l/
Be
h
ea
lth
ot
io
Em
Ap
p
ro
pr
ia
te
H
Pl
ac
em
en
Pe
t
rm
an
en
cy
bi
lit
y
St
a
Sa
f
et
y
67%
80%
87%
100%
87%
85%
100%
2010-2011 n=30
83%
97%
100%
Child and Family Percent Acceptable
Non-Custodial Cases
2010-2011 All non-custodial cases n=30
In Child and Family Status, as might be predicted (and hoped for in a non-custodial population),
Family Functioning, Stability, and Permanency were all noticeably higher than in the custodial
population despite the shorter-term duration of most of the cases. This would be expected in
non-custodial cases because it had been determined at case opening that risks in the home were
not such that a custodial intervention was required to ensure Safety and Well-being. In 100% of
the non-custodial cases, Appropriateness of Placement rated acceptably, meaning that in each of
these cases the home or kin family setting was appropriate for receiving services. In only one of
the non-custodial cases was it determined that the family was not receiving services at a level
that risks were acceptably managed (NE-NC3). This case engendered much discussion among
reviewers, QSR staff and the regional staff. In custodial cases, the immediate safety issues have
been resolved by the removal of the child from the home, so the presence of a “minimally
unacceptable” Safety status points to a crisis situation. Even though it is rated on a six-point
scale like the other indicators, we became accustomed to thinking of Safety as an all-or-nothing
indicator. In this case, the child remaining in the home was seen as appropriate and the
interventions that had been planned for the family would likely resolve the risks after being
consistently implemented. “Permanency” was already acceptable and “Safety” was the desired
outcome of interventions that needed time to work; this is precisely the opposite of what we are
used to seeing in custodial cases. This case illustrates the complexity of the assessment and
decision-making that occurs in these non-custodial cases.
23
2010-2011 All custodial cases n=256
2010-2011 All non-custodial cases n=30
System Performance Percent Acceptable
Non-Custodial Cases
Te
am
w
69%
73%
50%
60%
60%
60%
50%
47%
57%
or
k
En
ga
ge
m
an
As
en
d
se
t
Co
ss
or
m
di
en
na
t&
tio
U
n
nd
er
st
an
Lo
di
ng
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
Pl
an
oc
es
Im
s
pl
em
Tr
ac
en
kin
ta
tio
g
n
&
Ad
ju
Re
st
so
m
en
ur
ce
t
Av
ai
la
In
bi
fo
lit
rm
y
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
si
tio
ni
ng
63%
77%
2010-2011 n=30
As the case discussed above illustrates, Assessment is thought of as the critical Practice skill
associated with non-custodial casework, indeed there is a case type called “Assessment” and
those workers are called “Assessment” workers. At the beginning of the non-custodial QSR
pilot, Field and Program staff identified Assessment as the area they expected to find the most
challenges. One challenge thought to have an impact on this was the shorter-term nature of the
casework. The other was in the quality of assessment tools and processes for non-custodial cases
and workers’ skill in using them effectively. Comparatively, the Practice Wheel indicators rated
acceptably at similar rates to custodial cases, with Assessment being only slightly lower than the
custodial sample. Still, among the non-custodial cases it was the only Practice Wheel indicator
to rate acceptably in less than half of the cases.
In some cases, there is not a clear purpose around which to focus interventions. Sometimes this
is the result of a case opening at the request of courts seeking more information about a family
involved in a custody dispute, as in KX-NC1, KX-NC2, and SW-NC2. While these cases did
show opportunity to engage and provide services to meet an identified need, it appears that an
actual closure timeframe is tied to the resolution of the court case rather than a team’s
determination that desired outcomes have been achieved. The most successful Practice Wheel
outcomes among those cases was seen when both parents, despite their conflict, were engaged
with a “team” around common outcomes. In another case, UC-NC3, the initial referral led to
ongoing services to maintain a child in the home with his mother. Her mental health issues
continued to escalate, and the child’s father was granted custody. Confusion then arose as to
what the goal of DCS involvement should be. Court reviews were scheduled to review the
24
mother’s progress on the service plan, but at least for the near future the placement with the
father appears more viable. While the team can identify services that support Family
Functioning, they have not articulated when they think the Department will be able to exit the
case.
In other cases, concerns behind the initial referrals were truly “unfounded,” as in SH-NC2, NENC1, TV-NC1, and TV-NC3. In two of these cases, the Department’s presence is not
contributing to improved safety and feels intrusive (SH-NC2 and TV-NC1). However, in the
other two cases, (ET-NC1 and TV-NC3), the workers overcame initial resistance of the family’s
and, although the presenting issue in the referral was not identified as a “founded” incident of
maltreatment, was able to improve ongoing family functioning by addressing underlying needs
identified through work with the families. In ET-NC1, communication between the mother and
teenage youth contributed to circumstances that would have likely brought the youth to DCS
attention as a probation case, if not through CPS-Assessment services. In TV-NC3, the worker’s
“non-judgmental approach” helped form a team and resulted in improved communication
between the family and the school. The worker also helped the family identify financial
resources specific to home repair. Both of the families are highly satisfied with the Department’s
intervention. While Assessment is clearly an important factor, the degree to which families are
Engaged in that assessment and in determining the level of involvement is critical to Department
involvement being supportive or feeling intrusive.
Permanence
Over the past four years, the percentage of custodial cases with an acceptable rating on Prospects
for Permanence has doubled. In order for a case to be considered acceptable on this indicator,
there must be evidence that the Child and Family Team is implementing “a realistic and
achievable child and family plan” and the permanent home has been identified. The “work” of
the child welfare system is captured in the System Performance Indicators, and the “work
product” is the Child and Family Status Indicators. Permanence and Family Functioning
especially are dependent on practice, as these represent the “end products” of DCS involvement.
Improvements have been noted across the Practice Wheel indicators, and the improvements on
Permanence and Family Functioning and Resourcefulness clearly validate that those practice
improvements are helping achieve desired outcomes for children and families.
Cases reviewed that had achieved positive outcomes on Permanence tended to also have defined,
although to varying degrees, some form of a Long-Term View. Cases where positive results on
Permanency were present or anticipated soon sometimes showed strength in effective Transition
plans, informed by the Long-Term View. Ongoing Functional Assessment could also be linked
to Long-Term View, especially in helping teams identify what information they needed to
understand in order to make the most sensible plans for long-term success. Planning processes
that could rapidly adjust to changing circumstances in the case also contributed to achieving
positive results, as noted in cases from East, Knox, Mid-Cumberland, and Northwest. Other
successful strategies seen in cases rating acceptably on Prospects for Permanence included:
25
•
•
•
•
Positive connections were maintained between children/youth and their families. In
Juvenile Justice cases especially, there were excellent examples of family connections
and visits occurring despite distance between the youth’s placement and the family’s
home, particularly in cases from East, Knox, Tennessee Valley, and Upper Cumberland.
Frequent, even daily contact with parents was noted in cases from South Central and
Davidson; far from simply being a nice circumstance of the case, these frequent contacts
were being used by the team to inform the Ongoing Functional Assessment and Child and
Family Planning Process.
Progressive visitation is a successful strategy, used pretty widely in Reunification cases.
Cases from Davidson, East, South Central, and Upper Cumberland gave examples of this.
Teams with good communication and good supports, many informal, that can assess how
visits are going are very helpful in supporting these strategies.
True concurrent planning, a cohesive team working more than one goal, worked well in
cases where potential permanency resources were identified and concurrent goals were
identified at the beginning of cases (typical when concurrent planning involved a relative)
and where teams supported relationships between birth parents and resource parents.
Early work to identify fathers and extended family not only yielded potential permanency
resource, but also yielded results with identifying family supports. Diligent searches and
work with families to identify these resources was particularly evident in Northwest,
Shelby, and Tennessee Valley cases.
In cases that were experiencing challenges to achieving Permanence, there were both practice
and system support issues present. Just as a Long-Term View could assist teams, the lack of a
Long-Term View presented challenges especially when other areas of team functioning were not
adequate. When team members did not have a shared understanding of what the team was
working toward, often case progress suffered. If team members did not support a familycentered approach, either because they did not understand team roles or because they simply
disagreed with it, very little progress could be seen. When decisions were made based on rules
(real or just understood), rather than individual circumstances, cases could stall completely.
Examples of both excellent, creative family-centered work and cases where the family-centered
approach was lacking were seen in nearly every region. Both Knox and Upper Cumberland
showed very creative approaches to family-centered work in some cases, while allowing
themselves to be limited by restrictive punitive approaches in other cases. Ongoing Functional
Assessment issues were challenges in Shelby and Smoky Mountain in particular, where there
were examples of cases where teams had worked a significant amount of a plan but still felt they
could not return children home. Despite having examples of success reaching out to paternal
and extended family, Shelby and Smoky Mountain also have examples where there were
opportunities to strengthen the likelihood of achieving positive outcomes by working with both
parents.
Some other challenges are evident, many being “systemic issues,” that is, individual teams may
not be able to solve the problem itself although they may be able to plan effectively with some
support around these issues. Leadership at the Regional and Central Office levels, however, may
be able to support work with families by addressing some of these issues:
26
•
•
•
•
Turnover in staff, including staff at residential placements and private agencies, creates
challenges when it leads to gaps in information sharing or support to birth and resource
parents.
In adoption cases, challenges were noted in completing administrative processes (beyond
achieving full guardianship). In some regions, clarity around roles and responsibilities
for completing pre-placement summaries and other adoption work between DCS and the
private agencies would likely have helped move cases forward more quickly. TFACTS
implementation this year also presented a challenge as some time was spent getting
accustomed to the new system; it is anticipated that this will be less of an issue next year
as the implementation, not the system itself, was identified as the source of the
challenges. A specific understanding of the documentation required to ensure ongoing
TennCare coverage was also noted; Permanency Specialists are typically quite aware of
this information but are not always available to teams when these questions arise.
The Shelby region is absorbing a delinquent population previously served by the Youth
Services Bureau. A comparably high proportion of cases from Shelby have determinate
sentences.
There is a great deal of variance in the speed with which cases move through the court
system, and there does not appear to be much consistency or predictability to which cases
will be tied up. However, a few themes were evident. Turnover in DCS legal staff and in
court staff was cited as a factor in timeliness of petitions being heard. In cases involving
other systems, such as cases where there are pending criminal charges against parents,
cases could take quite a long time to be heard. Adjudications were sometimes not
received for weeks or months, and this appears fairly common in some courts in Shelby
and Upper Cumberland. Courts and families in a couple of cases were clearly out of sync
as far as what was a reasonable period of time to finalize an adoption, with families and
youth anxious to complete the process and clearly perceiving this to not be a priority for
the court. And, perhaps most frustratingly, a lack of consistency between courts around
requirements and preferences for petitions means DCS attorneys and DCS staff need to
become experts on the customs of particular courts.
Permanency Goal
For each case, reviewers are asked to record the “working” goal(s) of the team. The “working”
definition is used to ensure that the practice in cases is rated based on what the team is actually
working toward, since there are times in every case when the written plan could be out of date –
for example, when a goal changes and the new plan has not been ratified yet or data entry into
the system has not yet occurred. Thus, the following charts show the percentage of cases rating
acceptable by the goal identified by reviewers as the “working” goal. The most frequently
occurring goals are represented here.
Sole Goals
Outcomes for children and youth with an Adoption goal and an Exit to kin goal were quite
strong. Generally by the time Exit to kin is the sole goal identified on a plan the permanency
resource is clearly identified and committed. Permanency rated acceptable in 62% of the Exit to
kin cases, a notable improvement over the past few years with the implementation of Subsidized
27
Permanent Guardianship, the Relative Caregiver Program, and other initiatives within the system
to help support enduring relative placements. Adoption cases did “next best” at 39%. Practice
Wheel indicators were very strong in this group, pointing to process-related issues (including
court, adoption assistance, and in a few cases an adoptive resource was yet to be identified).
Process-related issues may also be dampening Permanency in Reunification cases; these cases
are sometimes open only a few months at the time of review and one would not necessarily
expect that Permanency would be achieved so quickly. Still, the rating on Family Functioning is
much higher than that on Permanency, begging the question as to what remains to be done in
order to reunify. Practice Wheel indicators are improving, but the ratings suggest that a key
practice opportunity for our system continues to be work with birth families.
2010-2011 All custodial cases n=256
Child and Family Percent Acceptable
Custodial Cases
2010-2011 Reunification n=110
2010-2011 Adoption n=59
79%
81%
81%
tis
fa
ct
io
n
39% n=23
ct
io
ns
ne
Co
n
m
ily
Fa
m
ily
Fa
C
ar
e
74%
65%
75%
56%
16% n=19
tio
Fu
nc
ct
Fu
n
gi
ve
r
l/
B
na
ni
ng
in
g
io
n
ar
ni
ng
eh
av
io
Le
ra
l
th
ea
l
H
Em
ot
io
Pe
rm
an
en
t
cy
32%
39%
pr
o
pr
ia
t
e
Pl
ac
em
en
ilit
y
St
ab
fe
ty
Sa
Ap
Sa
92%
85%
78%
73%
62%
65%
75%
65%
79%
93%
99%
98%
100%
89%
92%
88%
97%
100%
92%
98%
95%
90%
Sole Goals
2010-2011 Exit to kin n=26
In cases with a sole goal of adoption, most are of children already in full guardianship. In that instance, Family
Functioning is not rated and Family Connections is only rated based on siblings or other significant family
relationships that would be appropriate to continue post-TPR. The number of cases for which these indicators were
relevant is included above; one would not expect Family Functioning to rate at a high level of acceptability if
Adoption is a sole goal.
28
2010-2011 All custodial cases n=256
67%
62%
78%
73%
63%
66%
65%
77%
42%
50%
53%
59%
68%
65%
51%
ng
sit
io
Tr
an
up
po
tS
ni
rts
ts
pp
or
Pl
ac
em
en
Su
or
m
al
ce
ur
es
o
R
In
f
st
m
Av
ai
la
bi
lity
en
t
n
Ad
ju
&
Tr
ac
ki
ng
Pl
an
Im
pl
em
en
Pr
o
ni
ng
ta
tio
ce
ss
w
Vi
e
-T
er
m
ng
Pl
an
t&
Lo
Un
d
er
st
an
d
tio
in
a
oo
rd
C
d
As
se
ss
m
en
an
k
in
n
t
em
en
ga
g
En
am
wo
r
Te
g
31%
47%
52%
58%
59%
62%
68%
73%
73%
76%
62%
59%
88%
85%
Sole Goals
2010-2011 Exit to kin n=26
61%
2010-2011 Adoption n=59
94%
95%
95%
System Performance Percent Acceptable
Custodial Cases
2010-2011 Reunification n=110
Concurrent Goals
Only a small percentage of cases actually show a working concurrent goal of
reunification/adoption. Most of the cases showing concurrent reunification/adoption goals began
as sole reunification but adoption was added after the children either had been in custody a
prescribed amount of time or reunification did not appear to be viable, which no doubt had some
influence on the ratings reflecting several challenges in the cases. Because the ratings for
concurrent reunification/adoption cases were so distinct from other cases, a workgroup that
comprised Central Office Program staff in Safety, Permanency Planning, Recruitment and
Retention, Continuous Quality Improvement, and the Brian A. monitor’s office was brought
together to review the 19 case stories and discuss practice and systemic issues noted in the cases.
Trends that emerged included:
•
•
Staff appear to be adding adoption based on a belief that they have to when a child has
been in custody a particular amount of time, even when the Child and Family Team may
not believe adoption is in the best interest of the child and family.
Across the state, among field staff there seems to be some inconsistency around what the
role of team members are and to what degree legal team members participate in decisionmaking when it comes to adding adoption to the plan. Team members in one instance
perceived the DCS attorney was in charge of driving the decision to adoption, although
the rest of the team were still working with the mother and mentoring her on parenting.
Confusion and mistrust between team members seemed to be a result of this dynamic.
29
•
•
Evidence that adoption was truly being worked as a concurrent goal would include more
than just a verbal agreement from the resource parents that they are willing to adopt.
Permanency Specialists are the Department experts on Adoption Assistance and
explaining the process of adoption to the resource parents; however, it is generally
accepted in the field that Permanency Specialists are not available to teams until adoption
is a sole goal and children are in full guardianship. This effectively prevents concurrent
planning from occurring in many cases. Clarification around this issue is expected as
program staff and regional staff have conversations specifically addressing the steps can
be taken toward adoption prior to full guardianship being attained. These sessions are
scheduled to begin in the winter of 2011/2012.
In several cases, workgroup members identified missed opportunities at the beginning of
casework that were contributing to challenges later. In a few, diligent searches were not
conducted (or conducted well) so that there was an extended period of time that cases
were in concurrent limbo – that is, steps had to be completed in locating fathers before
TPR could be pursued although the team had effectively abandoned reunification. In one
case, this resulted in a viable relative appearing later on, changing the permanency
conversation also. In other cases, the Ongoing Functional Assessment of the family’s
strengths and needs did not yield a satisfactory plan that, once implemented, team
members believed had achieved the conditions necessary for reunification. These cases
are especially challenging, as there may be few obvious conditions for TPR when the
parent has participated in the requested services. Adoption is really the only option to
put on the plan for youth who are not approved for a goal of PPLA. The unit struggles
with cases where poor outcomes related to poor practice in the early years of the case
contribute to the desire not to adopt now. While some of these cases may reflect the
legacy of prior practice, it may be useful to acknowledge as a system that the approval of
PPLA now is not intended to validate earlier practice but to reflect the current best
interest of the youth. We may see some negative impact from these legacy cases until
they work their way out of our system; the key point is to make sure that our current
implementation of practice is meeting the needs of youth and families.
30
or
k
em
en
t
13%
33%
45%
53%
55%
89%
84%
Concurrent Goals
on
in
g
16%
40%
30%
21%
16%
2010-2011 Reunification/Exit to kin n=20
45%
2010-2011 Reunification/Adoption n=19
16%
50%
2010-2011 All custodial cases n=256
40%
35%
32%
50%
pr
o
pr
ia
t
C
Fa
m
ily
Sa
tis
tio
n
tio
ns
fa
c
ne
c
ng
ni
ng
ni
Fu
nc
tio
ct
io
g
or
al
ea
lth
nc
y
Le
ar
ni
n
Co
n
Fa
m
ily
H
eh
av
i
Fu
n
l/
B
ar
eg
ive
r
ilit
y
Pl
ac
em
en
t
St
ab
Pe
rm
an
e
e
Em
ot
io
na
Ap
fe
ty
0%
11%
15%
44%
39%
16%
55%
84%
75%
89%
95%
74%
80%
95%
100%
84%
90%
75%
84%
68%
100%
95%
2010-2011 Reunification/Exit to kin n=20
11%
5%
21%
Sa
2010-2011 Reunification/Adoption n=19
Tr
an
sit
i
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
ew
Pl
an
ni
ng
Pr
oc
es
Pl
s
an
Im
pl
em
en
ta
Tr
tio
ac
n
kin
g
&
Ad
ju
st
m
en
Re
t
so
ur
ce
Av
ai
la
bi
lity
In
fo
rm
al
Su
pp
or
Pl
ts
ac
em
en
tS
up
po
rts
Co
or
di
na
tio
n
En
ga
g
an
d
en
t&
w
As
se
ss
m
Te
am
2010-2011 All custodial cases n=256
Child and Family Percent Acceptable
Custodial Cases
Concurrent Goals
System Performance Percent Acceptable
Custodial Cases
31
Placement Type
When cases were sorted based on placement type, a few trends emerged. Notable differences
occurred between “temporary” placements, - that is, placements providing substitute care until
the families could support reunification or an adoptive placement was identified. Placements
where the child is expected to remain until maturity, for example in their family home or in an
adoptive placement are referred to here as “permanent” placements. Cases were also grouped
according to whether a placement was attached to a provider agency or DCS and family care or
congregate care.
“Temporary” Placements
DCS and Agency resource homes are still “temporary” placements at the time of review for the
children and youth placed in them, although some may become permanent placements in the
future. These placements tend to capture children and youth at the beginning and middle of the
custodial episode, whereas the adoptive and THV placements above generally reflected the end
of the custodial episode. Placements captured under “kinship” are more likely to include cases
from all through the spectrum, so in part some of the difference in Permanency ratings may be
attributed to cases where the relative placements have been identified as a permanency resource
if reunification turns out to not be a viable goal. Family Connections is a noticeable strength in
kinship cases, as is Family Functioning. Among System Performance indicators, Informal
Supports is also very high compared with other types of temporary family placements.
Child and Family Percent Acceptable
Custodial Cases
74%
37%
45%
55%
32%
50%
n
ac
tio
is
f
ne
C
on
Sa
t
ct
io
ns
16%
in
g
ily
Fa
m
Fa
m
ily
Fu
Fu
n
nc
t
ct
io
io
n
ni
ng
in
g
ar
n
Le
eg
iv
er
ot
Em
C
ar
av
io
r
al
lth
io
na
l/
Be
h
nc
m
an
e
H
ea
y
16%
16%
P
e
ia
t
Pe
r
la
ce
m
en
t
bi
lit
y
St
a
ro
pr
Ap
p
y
Sa
fe
t
75%
76%
74%
96%
96%
93%
77%
64%
78%
79%
80%
92%
87%
96%
100%
98%
100%
Kinship, DCS, and Agency Resource Placements
96%
93%
92%
88%
100%
96%
98%
2010-2011 All custodial cases n=256
2010-2011 Kinship home n=24
2010-2011 DCS resource home n=45
2010-2011 Agency resource homes n=61
32
Among temporary family placements, Practice Wheel indicators and Transitioning were most
strong in Kinship placements, with Long-Term View also being relatively strong compared to
other indicators. This may be a reflection of the “Plan B” or concurrent work present in many
kinship placements. There were four cases where Engagement was not acceptable but
Teamwork and other Practice Wheel indicators were; these four cases reflect circumstances
where relatives are available to take custody of the children if necessary, but birth parents are
struggling to maintain involvement with the team due to ongoing issues or simply giving up on
reunification (ET-16, KX-02, MC-17, and NW-19). It seems that in some cases family dynamics
between birth parents and their relatives can play into whether or not a parent is able to
effectively “ask” their family to care for their children or admit to them they are not able to. In
each of these cases the children and youth are in stable placements with their relatives, and the
forecast for the children was to improve or remain the same.
Barriers that exist in making kinship placements involve processes that are determined, in some
cases, outside DCS. The Interstate Compact (ICPC) process can be very time-consuming. Some
relatives in metro areas that cross two states, like Chattanooga and Memphis, have offered to
move to a part of the city in Tennessee, but are still required to reside at one address for six
months before the home study in order for background checks to be considered valid. Minor
criminal histories can also pose barriers to being an approved placement that comes with the
supports available to expedited placements, even when team members “on the ground” with the
families do not believe the criminal history indicates a present safety concern. Continuing to
develop safe and sensible means of making relative placements would likely benefit outcomes.
The major opportunity cited that, if addressed, would probably raise the percentage of Kinship
cases rating acceptably on Placement Supports, was timelier board payments. DCS has been
responding in some cases where financial need is present by paying utility bills, for example;
still, there may be opportunities to speed up the process of securing board payments and avoid
financial hardship.
33
93%
93%
67%
75%
74%
53%
51%
24%
35%
40%
41%
44%
62%
71%
88%
31%
23%
33%
39%
63%
67%
63%
67%
49%
49%
54%
44%
52%
As
se
ss
m
Te
am
w
or
k
an
d
Co
or
di
na
en
tio
t&
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
ew
Pl
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
en
Tr
ta
ac
tio
k in
n
g
&
Ad
ju
st
m
Re
en
so
t
ur
ce
Av
ai
la
bi
lity
In
fo
rm
al
Su
pp
Pl
or
ac
ts
em
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
en
t
em
En
ga
g
82%
Kinship, DCS, and Agency Resource Placements
2010-2011 Agency resource homes n=61
33%
2010-2011 DCS resource home n=45
System Performance Percent Acceptable
Custodial Cases
71%
2010-2011 Kinship home n=24
38%
44%
2010-2011 All custodial cases n=256
“Permanent” Placements
Predictably, the indicator capturing Permanence rated the highest on cases where children were
placed into Adoptive homes or were home on Trial Home Visits or placed in-home. These
placements are generally made at the end of custodial services, and so provide some insight into
Safety and Well-being at the time an exit from custody is anticipated. They also provide a
picture of what System Performance outcomes look like around the time custodial service
involvement is waning and involvement from ongoing services and the family’s informal support
system should be increasing. The Well-being indicators were also very high in these cases,
suggesting that children are not returning home “too soon” or that Safety and Well-being are
compromised for a shorter length of stay. Additionally, the rating on Family Functioning and
Resourcefulness suggests that positive changes occurred within the home and family.
34
2010-2011 All custodial cases n=256
Child and Family Percent Acceptable
Custodial Cases
2010-2011 THV or in-home n=42
83%
84%
95%
100%
100%
100%
88%
96%
60%
n
tio
tis
fa
c
Sa
Fa
m
ily
Co
n
ne
ct
io
Fu
n
ct
io
ns
ni
ng
in
g
io
n
ct
m
ily
ar
eg
ive
C
Fa
rF
un
Le
ar
ni
ng
ra
l
l/
B
eh
av
io
ea
lth
na
cy
rm
an
en
t
Pe
H
Em
ot
io
Ap
pr
o
pr
ia
t
e
Pl
ac
em
en
ilit
y
St
ab
Sa
fe
ty
43%
67%
76%
68%
93%
91%
100%
96%
95%
100%
THV, In-home, or Adoptive Placement
84%
95%
100%
2010-2011 Adoptive homes n=25
A note on the chart: Family Functioning was applicable in only 7 adoption cases; these are cases where full guardianship has not
yet been achieved. Family Connections is also only applicable in 13 cases, 11 of these are of kids who are placed in-home or on
THV but who still have siblings or other meaningful family members remaining outside the home. For the 2 Adoptive Home
cases that did not rate acceptably the lack of connection reflects one birth father who reported he was asked not to contact the
children and he is not contesting TPR (KX-20). Although extended family has been contacted for visits in TV-08, the local judge
does not approve of children visiting with their parents while their parents are in jail. The TPR hearing had not occurred in that
court yet at the time of review, although presumably TPR would occur at which time Family Connections could become Not
Applicable in that case.
Performance on Practice Wheel Indicators and Transitioning are also quite strong in these cases
compared with the overall review sample. For cases with children and youth on Trial Home
Visits, it appears a primary practice opportunity is to strengthen the development of a LongTerm View and Transition planning. This would likely help improve Stability, the primary
challenge on the status side, as well. For adoption cases, System Performance is quite strong
until Plan Implementation, suggesting some systemic barriers may be presenting challenges for
even the most cohesive teams. Several case stories indicate opportunities to increase these
indicators are primarily based in making sure all the “steps” involved in adoption planning, from
specific court requirements for finalization and Adoption Assistance are well-understood.
Several suggested the involvement of Permanency Specialists was an asset in this area of
planning, and some recommended their involvement earlier so that resource parents have a
35
91%
64%
76%
67%
72%
74%
60%
71%
72%
80%
55%
Te
am
w
En
ga
ge
or
m
k
en
an
t
As
d
C
se
o
or
ss
di
m
na
en
tio
t&
n
U
nd
er
st
an
di
ng
Lo
ng
-T
er
m
Vi
ew
Pl
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
en
Tr
ta
ac
t io
ki
ng
n
&
Ad
ju
st
R
m
es
en
ou
t
rc
e
Av
ai
la
bi
In
lity
fo
rm
al
Su
pp
Pl
or
ac
ts
em
en
tS
up
po
rts
Tr
an
si
tio
ni
ng
64%
84%
THV, In-home, or Adoptive Placement
76%
84%
81%
88%
2010-2011 Adoptive homes n=25
86%
92%
2010-2011 THV or in-home n=42
92%
System Performance Percent Acceptable
Custodial Cases
2010-2011 All custodial cases n=256
100%
96%
clearer picture of what the adoption process looks like and what they can expect from services
after finalization.
Congregate Care and Family Placements
When cases are sorted based on congregate or family settings, there are some key differences in
outcomes that are observed, many not surprising. Youth in congregate settings in this review
were placed to address a serious mental health or behavioral issue.3 A meaningful trend
identified here is that for youth in congregate care and children in family settings, Safety, Health,
Caregiver Functioning, and Satisfaction with services was quite high for both groups. Some of
the differences observed in the ratings between youth in congregate care and children placed in
family settings are not surprising, given the largely different circumstances present in a case
prior to placement. Placements in residential treatment, for instance, are often made after lower
levels of care have been unsuccessful, contributing to lower percentages of acceptable ratings in
Stability. For a similar reason, teams may be working toward supporting Emotional/Behavioral
3
Only one youth was placed in an Independent Living program at the time of the review (SC-22 JJ). He was placed
there after completing residential treatment for sexual offenders. His commitment order was changed from a
determinate to indeterminate sentence during his time in custody, but an agreement was reached between the youth’s
attorney and the District Attorney that he would remain in custody until age 19. If he were to leave custody prior to
his 19th birthday, he could face his remaining open charge for sexual battery as an adult. The youth will not be
returning home but is able to attend college in his current IL placement. The child this youth committed crimes
against continues to live in the same neighborhood as the youth’s parents, and both the victim’s family and the
youth’s attorney were in support of this arrangement.
36
Well-being and Learning and Development but are starting from a different point with youth
experiencing mental health problems. However, Appropriateness of Placement is a concern for
those in congregate care. Generally, a key challenge was finding a suitable step-down placement
rather than the placement having been unacceptable when the placement was made. An
important distinction in these cases is the maintenance of Family Connections for youth in
congregate care; the higher ratings for congregate care is due almost entirely to the Juvenile
Justice facilities (YDCs and Group Homes); when Brian A. class members are compared, the
difference between groups is negligible.
Child and Family Percent Acceptable
2010-2011 Congregate Settings n=59
Custodial Cases
2010-2011 Family Settings n=197
67%
53%
53%
45%
n
tis
fa
ct
io
Co
n
Fa
m
ily
Sa
ct
io
ns
ne
ct
io
Fu
n
Fa
m
ily
Fu
n
gi
ve
r
C
ar
e
na
ni
ng
in
g
ct
io
n
ar
ni
ng
eh
av
io
l/
B
Le
ra
l
th
ea
l
cy
rm
an
en
t
Pe
H
Em
ot
io
Ap
pr
o
pr
ia
t
e
Pl
ac
em
en
ilit
y
St
ab
Sa
fe
ty
22%
40%
46%
On the Practice Wheel indicators, differences in the ratings between the groups are much
smaller. Placement Supports was a strength for both types of placements, a very positive
indication that the Department and Provider Agencies are able to effectively provide support to a
variety of settings. In Engagement, Plan Implementation, and Tracking and Adjustment, the
ratings were very similar. The ratings on Teamwork and Coordination and Long-term View
suggest that among congregate placements, an opportunity may be to ensure that a familycentered approach and work toward a Long-Term View is present to the same degree as it is in
family settings. Congregate settings are identified to meet specific needs of youth, and the
challenge may be in achieving the balance between managing the urgent needs that elicit reactive
practice within the framework of achieving a Long-term View for Safety, Stability, and
Permanence. It may be counterintuitive that Resource Availability and Use is comparatively
strong in the family settings, reflecting a lower level of care; however, the challenges present in
37
80%
78%
96%
86%
68%
73%
86%
95%
98%
99%
94%
73%
73%
98%
97%
Congregate and Family Settings
this indicator and in Informal Supports typically speak to a lack of involvement with the family.
Distance between home communities and specialized settings can present a barrier to fully
implementing family-centered practice.
45%
51%
67%
io
n
sit
up
po
tS
Pl
ac
em
en
in
rts
g
46%
ts
Su
pp
or
lity
In
f
ce
R
es
o
ur
&
ng
ki
Tr
ac
or
m
al
Av
ai
la
bi
st
m
Ad
ju
em
en
58%
53%
54%
en
t
n
ta
tio
ce
ss
Im
pl
Pl
an
ni
ng
Pr
o
Vi
e
Pl
an
53%
52%
49%
55%
34%
44%
w
g
Lo
ng
er
st
Un
d
t&
m
en
As
se
ss
-T
er
m
an
d
tio
in
a
oo
rd
C
d
an
k
in
n
t
em
en
ga
g
En
am
wo
r
Te
46%
52%
61%
49%
58%
61%
76%
Congregate and Family Settings
Tr
an
2010-2011 Family Settings n=197
95%
92%
System Performance Percent Acceptable
Custodial Cases
2010-2011 Congregate Settings n=59
Provider Agency and DCS Placements
When looking at placement by agency affiliation, there are few distinctions between cases on
any indicators other than Stability. This is in part due to agency providers representing the
higher levels of care among family settings and the residential treatment facilities. Nearly all of
the kinship placements, the placement type with the highest percentage of acceptable Stability
ratings, are DCS approved homes. Once again, Placement Supports was a strength in both
groups. The majority of the Practice Wheel indicators are very similar between groups, which
may indicate that, encouragingly, there is consistency in practice across teams with and without
Agency Caseworkers. Resource Parents and staff in congregate facilities are critical Child and
Family Team members, and these differences may indicate consistency in expectation for
participation. Long-term View stands out as the Practice Wheel indicator with the largest
discrepancy between groups, some of which like Stability is accounted for by the type of
placement mentioned in the preceding section. However, there may be opportunities to ensure
that FSWs maintain the focus on Long-term View for children and families, even when other
professionals on the team are working heavily towards completion of a specific treatment or
program.
38
As
se
s
k
&
Ad
ju
st
m
en
t
ta
tio
n
ce
ss
Av
ai
la
bi
lity
In
fo
rm
al
Su
pp
Pl
or
ac
ts
em
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
rc
e
ng
Im
pl
em
en
es
ou
Tr
ac
ki
Pl
an
Pr
o
Vi
ew
in
g
n
t
74%
69%
Agency and DCS Settings
93%
93%
System Performance Percent Acceptable
Custodial Cases
48%
50%
60%
64%
53%
55%
53%
51%
53%
55%
39%
45%
52%
49%
59%
59%
61%
60%
2010-2011 DCS Placements n=121
in
g
-T
er
m
er
st
an
d
tio
em
en
oo
rd
in
a
ga
g
pr
o
C
Fa
m
ily
Sa
ra
l
th
n
ct
io
ns
ni
ng
ng
tis
fa
ct
io
ne
ct
io
ni
ar
ni
ng
ct
io
Fu
n
Co
n
m
ily
Fu
n
Le
io
ea
l
cy
t
ilit
y
en
eh
av
H
rm
an
l/
B
gi
ve
r
Fa
ar
e
St
ab
fe
ty
Pl
ac
em
en
Pe
e
na
pr
ia
t
Em
ot
io
Ap
Sa
58%
57%
49%
46%
33%
38%
59%
80%
79%
94%
97%
80%
86%
100%
98%
87%
92%
79%
84%
75%
99%
97%
2010-2011 DCS Placements n=121
R
C
Un
d
d
Lo
ng
&
an
En
2010-2011 Agency Placement n=135
Pl
an
n
sm
en
t
Te
am
wo
r
2010-2011 Agency Placement n=135
Child and Family Percent Acceptable
Custodial Cases
Agency and DCS Placements
39
Recruitment and Retention
Placement Supports, an indicator capturing the support provided by DCS, private agencies, and
other entities within the child welfare system to both resource parents and congregate care
facilities, has been a consistently high rating indicator each year of review. Paid placements
such as DCS and private agency resource homes and congregate care placements rate
particularly high, with 95% of the congregate placements rating acceptably. Both DCS and
private agency resource homes rated at 93%. Specific strengths reported throughout the year
related to this indicator include:
•
•
•
•
Resource Parents have their own strong support systems that are encouraged to become
“informal supports” to the children in their care, seen in South Central and Northeast.
Resource Parents reported good support from DCS FSWs and/or private agency case
managers. This was noted in cases where there were frequent visits made to the resource
home by these workers. Support from the DCS FSW was particularly important in cases
where the resource parents hoped to adopt. There were examples of cases in Davidson,
Mid-Cumberland, Northeast, Northwest, Smoky Mountain, South Central, and Tennessee
Valley citing how important the DCS or agency worker contact and communication was
to helping support the placement and their caregiving of the children.
When regions supported the youth and families recruiting their own placement resources,
these tended to work very well. Not only does this reflect family-centered practice, but it
also contributed to positive outcomes as the trauma of removal was minimized when
children moved to placements that the birth families supported. East, Knox, Shelby,
Smoky Mountain, South Central, and Upper Cumberland all had cases where families
and youth had recruited the placement resources themselves.
Some regions especially had examples of cases where Resource Parent Support was
encouraging positive relationships between birth parents and resource parents, and these
resource parents also seemed to have an expectation that their work with children
extended to the families. Many resource families were able to articulate ways, through
some of this supportive work through the Child and Family Team, that they were
supporting reunification efforts even while being willing to adopt. The trend toward
positive relationships between birth and resource parents has been seen in Davidson for a
couple of years now, this year there were also examples of cases like this in MidCumberland, Northeast, Tennessee Valley, and Upper Cumberland.
While not speaking directly to Resource Placement or Congregate Care Supports, there were
cases where Child and Family Teams used strategies that were successful at building supports
among relatives even when those relatives could not be placement resources. Diligent searches
conducted very early in the life of DCS involvement also built support for non-custodial cases
also. Relatives that could not be placements could help make team decisions, as seen in cases
from Mid-Cumberland, Northwest, and Upper Cumberland.
Although well supported in a large majority of the cases, kinship placements as a group had the
lowest percentage of cases rating acceptably on Placement Supports. The issue in these cases
had to do with timely receipt of board payments. Some kinship caregiver providers were feeling
financial hardship during the approval process, and in some instances DCS was providing funds
40
for utility bills to offset the cost to the families when they were not receiving a board payment.
Still, a couple of families reported they were spending down their savings. These challenges
were seen in several regions. Although not yet reflecting kinship caregivers in most cases, a
related issue to kinship resource is the length of time the ICPC/ICJ process takes. Managing
connections during this time is challenging, and waiting for approval creates uncertainty over
several months. Child and Family Teams may be able to help normalize some of this experience
for relatives and current resource parents, as well as helping them understand what to expect
during this process. Kinship parents to a very large sibling group that was split between two
expedited homes noted that even then, respite placements where the children can go without
being separated further are not available.
Other areas of opportunity for all placements with regard to Placement Supports mainly related
to Teamwork-based issues around communication. Specific issues included:
•
•
•
Increasing the understanding of the Permanency Plan, or the planning process, would
assist resource parents who are either unable to support the plan with their current
knowledge or who feel unsure about how they can support the plan. Processes related to
permanent guardianship or adoption can also be confusing to resource parents, but even
in cases where there are concurrent goals in place Permanency Specialists are typically
not available or not utilized by teams until adoption becomes a sole goal or after children
are in full guardianship.
In a few cases, resource parents perceived a lack of communication during children’s
transitions from one placement to another. For resource parents, this resulted in the
feeling like they were not as equipped to meet children’s needs as they would have liked.
Turnover in private agency workers presented challenges in Resource Parent Supports
during those transitions, especially if there was not coverage for a period of time or
information was not effectively shared from one worker to another.
Youth
Youth age fourteen and older make up the largest age group of children reviewed, reflecting the
proportion of age groups in our custodial population. Typically, the youth in custody have more
challenges than do younger children in Well-being, as some struggle with mental health and/or
substance abuse issues. Learning and Development can be an additional challenge for youth
with these needs, especially when treatment needs require changes in school settings or when the
team needs to prioritize mental health stabilization over academic progress for a period of time.
The cumulative impact of behavioral or academic problems occurring over a longer school
career can result in youth getting further and further behind their peers. Stability also is a
challenge for more children in this age group than in others, but over the past three years
Stability has shown some improvement concurrent with improvements in System Performance
ratings. Over the past three years each of the System Performance indicators, Permanency, and
Family Functioning have shown improving trends. The majority of cases of youth reviewed this
year showed acceptable outcomes on Practice Wheel indicators, and the percentage of cases
rating acceptably on these indicators exceeded that of the statewide average. This reverses a
trend seen in previous years, where outcomes for youth tended to be below the statewide
41
average. A considerable amount of the improvement seen in the statewide ratings is reflective of
the improvements in Practice seen among this age group.
The following charts include youth in custody, age 14 or older, either adjudicated
Dependent/Neglected, Unruly, or Delinquent.
2008-2009 age 14 and older n=122
2009-2010 age 14 and older n=124
Sa
tis
fa
ct
io
n
56%
40%
46%
Le
ar
ar
ni
ng
eg
iv
er
Fu
nc
tio
ni
Fa
ng
m
il y
Fu
nc
tio
ni
Fa
ng
m
il y
C
on
ne
ct
io
ns
Be
ha
vi
or
al
49%
54%
61%
69%
71%
77%
75%
77%
85%
91%
88%
94%
2010-2011 age 14 and older n=118
C
Em
ot
io
na
l/
H
ea
lth
20%
28%
37%
en
cy
Pe
rm
an
en
t
Pl
ac
em
St
ab
il it
y
Ap
pr
op
ria
te
Sa
fe
ty
42%
56%
55%
63%
73%
75%
80%
81%
85%
94%
95%
97%
98%
98%
99%
Child and Family Status
Youth
Youth with acceptable Family Connections tended to have a more positive six-month forecast –
only two youth with a forecast of “decline” were rated as having acceptable Family Connections.
Supporting positive relationships with family members, even when it is unlikely to result in
Permanency, contributes to well-being for youth.
Engagement and Teamwork with the youth themselves was particularly strong, and this seems to
be the foundation for much of the practice improvement. Supports such as Education Specialists
were helping teams navigate credit challenges in some cases of youth in high school. The
involvement of Independent Living Specialists was helpful in most cases where youth were
receiving specific assistance around deciding on Post-Custody options. The East region, for
example, worked very well with the teens in their review, including youth struggling with serious
mental health and behavioral issues. Tennessee Valley seemed to have fewer challenges placing
children in their home communities than other regions. One issue that clearly informs their
placement decisions for youth is the high school schedule – they were able in some cases to keep
youth if not in the same school in a system that used the same block schedule so they wouldn’t
42
lose credits transferring between systems. A limited ability to ensure continuity of credits was
noted in a few cases reviewed in Mid-Cumberland, although teams were certainly aware of the
impact changing schedules had and were trying to avoid conflict. A challenge in that region is
that many of their agency resource homes, who provide placements for many youth, are
concentrated in one county in their region. There may be opportunities to develop strategies to
help ensure youth’s progress in high school is not adversely impacted by placement changes,
including regional assessment of the extent to which this impacts youth in their areas and
resource development. While there remain opportunities to strengthen Long-Term View, a
critical area for youth nearing a transition to adulthood, the work with the youth population is
very encouraging in its improvement.
50%
64%
tS
Pl
ac
em
en
In
fo
rm
al
S
up
po
rts
up
po
rts
28%
34%
46%
38%
52%
60%
73%
R
es
ou
rc
e
Av
ai
la
bi
li t
y
en
t
31%
38%
57%
58%
Tr
ac
ki
ng
&
Ad
ju
st
m
en
ta
tio
n
32%
33%
Pl
an
Im
pl
em
Pr
oc
es
s
26%
32%
Pl
an
ni
ng
Vi
ew
34%
42%
44%
55%
Lo
ng
-T
er
m
er
st
an
di
ng
32%
37%
43%
47%
en
t&
As
se
ss
m
wo
rk
an
d
C
Un
d
oo
rd
in
at
io
n
45%
46%
m
en
t
En
ga
ge
Te
am
58%
65%
66%
2010-2011 age 14 and older n=118
88%
86%
94%
System Performance
Youth
2009-2010 age 14 and older n=124
Tr
an
si
tio
ni
ng
2008-2009 age 14 and older n=122
Juvenile Justice
Fifty-six cases reviewed during the 2010-2011 statewide review cycle were of youth adjudicated
delinquent. An additional forty-six cases of delinquent youth were reviewed during the summer
of 2011 in the targeted reviews that took place in the YDCs. The charts used in this section
include those youth reviewed as part of the summer YDC reviews. To a great degree, practice
outcomes for youth adjudicated delinquent who are placed in family or residential
treatment/group home settings are fairly consistent with practice outcomes achieved for youth in
the Brian A. class. Permanency rated acceptably in exactly the same percentage of cases for
youth in the Brian A. class and youth adjudicated delinquent who were not placed in YDCs.
Outcomes on Family Connections were considerably higher than the Brian A. average. In many
43
cases, depending on case circumstances, the team recommends that youth and their families
receive some degree of family counseling prior to discharge. This likely supports Family
Functioning and Family Connections, as well as Transitioning from the System domain. YDC
placements were achieving positive outcomes for youth with regard to Safety, Health, and
Emotional Well-being, and Learning and Development at a rate consistent with those of Brian A.
youth. As with other JJ youth, Engagement showed the highest percentage of acceptable
outcomes among the Practice Wheel indicators.
Some youth exit to Trial Home Placements directly from YDC placements, but others do stepdown to lower levels of care before exiting custody. For purposes of classifying placements in
the following charts, youth on a Trial Home Placement at the time of their review are categorized
according to their prior placement. Twelve youth were on Trial Home Placements at the time of
their reviews, four who were counted as being in a YDC placement and eight in other types of
placements. Some of the difference in Permanency ratings across these groups can be explained
by some of the youth in non-YDC placements being at a phase of their case that represents the
latter part of their custodial stay, whereas for some youth the YDC represents an early or middle
part of their custodial stay. However, the indicators for Long-term View and Transitioning on
the YDC cases suggest that in most cases planning processes for youth in the YDCs are highly
focused on the short-term treatment goals for the youth while they are in the facility but less so
on a broad, family-centered plan to support long-term independence.
2010-2011 Brian A. youth n=62
Child and Family Percent Acceptable
Youth Adjudicated Delinquent
2010-2011 JJ youth in non-YDC placements n=37
2010-2011 YDC placements n=62
53%
61%
52%
81%
84%
84%
94%
93%
86%
71%
ar
eg
iv
er
Fu
nc
tio
Fa
ni
m
ng
il y
Fu
nc
tio
Fa
ni
m
ng
ily
C
on
ne
ct
io
ns
Sa
t is
fa
ct
io
n
Le
ar
ni
ng
C
Be
ha
vi
or
al
ea
lth
H
ot
io
na
l/
Em
en
cy
en
t
Pe
rm
an
Pl
ac
em
St
ab
ilit
y
Ap
pr
op
ria
te
Sa
fe
ty
11%
41%
59%
58%
76%
81%
84%
76%
97%
98%
100%
97%
Placement Type
44
YDC cases did not rate as well on System indicators as the other cases, with the exception of
Placement Support. A common theme among these cases, and one that likely underlies some of
the other challenges to a great degree, is that planning in these cases centers around program
completion and release from the facility rather than on successful achievement of a familycentered Long-term View. In short, the practice demonstrated in a number of cases is
inconsistent with our practice model, remaining very child focused as opposed to family
centered. Opportunities were identified for regional FSWs and YDC staff to team more
effectively together throughout the duration of a case, not just to concentrate efforts at the
youth’s entry into the facility and when a release is imminent. Commonly, the teaming process
within the YDC was described as a “treatment team” approach. This clearly has helped yield
good results in the Well-being indicators, and a strength identified in these cases is cohesion and
communication among treatment staff within the YDCs. However, until this process more
effectively integrates the Child and Family Team meeting approach, including family-centered
Assessment and Planning Process, and guided by a Long-term View, these cases will likely
continue to show lower percentages on desired practice outcomes.
2010-2011 JJ youth in non-YDC
placements n=37
97%
97%
System Performance Percent Acceptable
Youth Adjudicated Delinquent
2010-2011 Brian A. youth n=62
Placement Type
26%
37%
45%
46%
59%
62%
60%
59%
62%
40%
41%
g
io
n
sit
Tr
an
up
po
tS
em
en
in
rts
ts
pp
or
Su
Pl
ac
ur
es
o
or
m
al
ce
Av
Ad
ju
R
In
f
st
m
ai
la
bi
lity
en
t
n
&
ng
ki
Tr
ac
Im
pl
em
en
Pr
o
Pl
an
ni
ng
ta
tio
ce
ss
w
Vi
e
Pl
an
-T
er
m
ng
Lo
O
ng
oi
ng
Fu
nc
k
t io
an
d
na
C
lA
oo
rd
ss
es
in
a
tio
sm
en
n
t
em
en
ga
g
En
am
wo
r
Te
t
21%
35%
44%
62%
54%
45%
55%
62%
70%
2010-2011 YDC placements n=62
A notable number of youth reviewed during the summer YDC reviews have experienced the loss
of a parent or close family member, and in a few of the cases family members directly connected
the youth’s behavior problems with this loss. Nineteen of the forty-six youth reviewed during
the summer YDC reviews have lost either a parent or caregiving grandparent or sibling (this does
45
not include cases where one or both parents are “absent”). Two of these youth witnessed the
shooting death of their family’s loved one. Of these youth, some lost fathers not to death, but to
other unwanted separations. One is lost to TPR with no strategies in place to maintain family
connections (in this case, the 17 year-old youth sought him out during a runaway episode within
the year prior to the review); one began serving a 60-year prison sentence when the youth was in
elementary school; two youth discovered that the men they thought were their fathers are not;
and one father suffered a gunshot wound to the head resulting in a significant personality change.
In a handful of these cases, the surviving parent reported that this loss impacted the youth’s
behavior.
While therapeutic services were generally regarded to be of fairly high quality once received,
Resource Availability and Use and Plan Implementation outcomes were challenged by the
waiting lists for specific services within the YDCs. Waiting lists for Alcohol and Drug treatment
could be weeks to months long for certain youth depending on when a slot becomes available in
a beginning cohort. At Mountain View, staff attempted to mitigate this wait by adapting A&D
worksheets so that youth could work on them while awaiting a spot in the program, but even
with these adaptations the team acknowledged that this was not an effective substitution and for
the youth in MV-01, contributed to the Appropriateness of Placement rating being unacceptable.
Waiting lists impact other services, too. The plans for youth generally reflect a variety of
services identified for multiple issues, such as Aggression Replacement Training for behavior,
Individual Counseling, and Alcohol and Drug treatment. However, the YDCs are unable to
prioritize youth for services under the current system. One youth’s father, his only parent, died a
month after he was sent to the YDC (WH-09). Upon his father’s death, he spent four months on
a waiting list for grief and loss counseling before receiving it. Family therapy was an exception
to the waiting list issue – these cases did not include any youth on waiting lists to receive family
therapy, so it is likely this particular therapeutic intervention is generally available. However, an
issue that relates to family therapy is that it is often offered at the end of the youth’s stay, as a
transitioning strategy prior to going home. For a number of families, this results in missed
opportunities along the way, and reinforces the thinking that the “child’s problems” resulted in
custody. Cases where family involvement was encouraged throughout the duration of a case
provided many more opportunities for the team to achieve family-centered practice outcomes.
The YDC placements are the most restrictive placements available for youth adjudicated
delinquent; given this, Appropriateness of Placement is a significant indicator for this group.
Nearly a quarter of the cases reviewed over the summer noted that the YDC was not an
appropriate placement for the youth at the time of the review. Some of these youth were
struggling with mental health issues that the YDC program does not appear to be able to manage.
These youth were spending so much time on Special Population for behavioral violations they
were not able to complete the assigned treatment (NE-01 JJ, NE-10 JJ, WD-01 and MV-06).
These youth were benefitting from the security of the placement, especially those with histories
of runaway and whose behaviors are life-threatening while on run, but progress toward treatment
goals is disappointing. Along with the youth in ET-12 JJ, it appears for this group of youth a
different type of residential program would meet their needs more effectively than the YDC. For
many of the remaining youth for which the YDC was considered not to be an appropriate
placement, the YDC had been an appropriate placement when they arrived, and in fact they had
succeeded to the point where a lower level of care would meet their needs. Problems with
46
completion of necessary paperwork for release was an issue in WD-09 and WH-03, and an
incorrect release date entered into TFACTS makes it appear that the youth in WD-09 left custody
after his eighteenth birthday, when in fact he was released at age seventeen – he was denied entry
into an Independent Living program and “on paper” does not appear eligible for Chaffee funds.
The group home closure played a role in the placement of at least three youth into the YDCs; two
were eighteen at the time of the YDC placement so there were no alternatives for placement in
other residential programs and one youth was experiencing behavior problems in a group home
around the time they were closing (WH-06, TF-08, and NE-15 JJ). It was also identified for the
youth in WH-07 and WH-10. Although serving determinate sentences until age 19, YDC staff
indicated they were ready for step down but the limited availability of step-down placements
presented a barrier. The youth in WH-07 declined two open step-down placements because they
were far away from his family and they would be unable to visit.
A challenge not unique to the YDCs, but a factor in most of them, is the distance between the
YDCs and the families and FSWs. When staff at the YDC were able to be flexible with
visitation hours and in scheduling Child and Family Team Meetings, this tended to support
positive outcomes. When FSWs were available to visit frequently, this also supported positive
outcomes. The Department has recently worked to clarify transportation rules about FSWs
transporting family members in state vehicles for visits, and this may help increase the level of
Family Connection and Engagement in the Child and Family Team. Face-to-face visits had not
occurred between the youth and their family in over ten of these cases, with transportation and
scheduling being the primarily identified barrier. An ongoing project is to support work between
the YDCs and the regional field staff to devise ways the two entities can work more cohesively
in implementing family-centered practice. Ensuring that teams continue to work toward a Longterm View that the youth, family, and others have identified will likely help support practice
across several indicators.
Court & Legal System
This year, a few themes related to court issues emerged. Some challenges have been present
within the system and require some adjustment on the part of DCS staff, for instance in regions
where different courts follow different procedures and preferences regarding docket scheduling,
processes for filing petitions and documents with the court, and other issues that require staff to
become familiar with several court preferences. Other challenges were present in regions where
there was turnover among attorneys. DCS attorneys had to “cover” for each other in several
instances, and as it does with field staff this means additional time is spent on making sure
information and understanding is up-to-date.
Another opportunity within the Department is making sure that the way attorneys are supported
in their work is consistent with the broader mission of implementing best practice to empower
families and support community safety and partnerships. A major role for attorneys in achieving
permanency is securing TPR when adoption becomes the goal and parents do not agree to
surrender their rights. This may be a very visible role for attorneys, but it is required in a
minority of our cases. Even if unintended, a focus on legal staff on ensuring a case for TPR can
be made from the beginning of services can dampen engagement and reunification efforts.
47
Internal teaming between program staff and legal can help ensure the Department is handling
cases with a coordinated approach.
Delays in adjudication were seen in a number of cases, appearing as a trend in Shelby and Upper
Cumberland courts, where a great deal of time has been invested by the region to address this
issue. These resulted in returns of children to their families prior to the Department feeling
confident that a return would be safe and stable, while also contributing to challenges in working
toward timely reunification. In addition, some cases take so long to be adjudicated that even if
the team has moved away from a reunification goal it becomes very difficult to effectively work
toward anything else. The framework in which the Department must work is one in which the
timeframes for law enforcement and some courts do not necessarily match up with our best
practice timeline. This becomes particularly complicated in cases where an adjudication of
Severe Abuse is being sought. A targeted review of cases from the QSR review that involve a
severe abuse finding was completed to explore this further (see Appendix C). While 21 custodial
cases and one non-custodial case involved severe abuse findings, in only one did it appear that
Permanency (through adoption) would be achieved more timely (TV-17). There were few
visible differences between these cases and the Brian A. statewide average in terms of
Placement, Well-Being, and Conditions and Attributes of Practice indicators. However,
Permanency was also more challenged than in cases that did not involve severe abuse.
As the Practice Model endorses a team decision-making process, in cases where courts are the
primary decision-maker typically the outcomes are not positive. A practice opportunity is to
continue to work toward building family-centered teams even when a large part of the case
hinges on a court decision. A practice opportunity exists around implementing quality practice
and ensuring that team decisions are advocated for in court. It appears certain courts are taking
full advantage of their decision-making authority in areas where court staff are not confident in
the quality of the practice they see before them, frustrating efforts to implement team-based
decisions in some cases. One region that appears to have the confidence of most of their courts
is Northwest, where a number of cases saw extended Trial Home Visits and other visitation
strategies agreed to by the court at the behest of a Child and Family Team. This region has much
success with reunification, especially in cases involving drug use. It appears that the working
culture here, including providers and courts, accept the premise that child welfare and family life
in general carries inherent risk – so when minimally adequate parenting is achieved, the benefit
of the doubt goes toward reunification with whatever level of in-home services or extended
THVs are necessary to ensure safety and stability. This region also typically experiences low
turnover, meaning that court staff and DCS staff have opportunities to develop a degree of
professional trust over a period of time. In the 2011-2012 review cycle, the QSR protocol is
adding an indicator to capture information about how the child welfare system and the court
system are interfacing and working towards the shared desired outcomes of safety, permanency,
and well-being.
48
Appendices
49
Appendix A
Review Process
From August 2010 – August 2011, the Tennessee Department of Children’s Services (DCS) partnered
with the Tennessee Commission on Children and Youth (TCCY) and the Tennessee Center for Child
Welfare (TCCW) to conduct the Quality Service Review of cases in the Department’s twelve
administrative regions and five Youth Development Centers. Cases were reviewed over the course of
two days by two-person teams made up of one lead reviewer and one shadow. DCS, TCCW and TCCY
were joined by reviewers and shadows from our own and partner agencies. In the regionally-based
reviews, the custodial cases were selected by TCCY based on a sampling matrix assuring that a
representative group of cases was reviewed. Custodial cases were stratified based on regional
demographics including age, adjudication, race, and gender. Three non-custodial cases were selected
randomly by DCS central office. In the YDC-based reviews, cases were also selected by TCCY based
on a random sample of the population of youth in each facility.
Feedback was provided verbally when review teams met with Family Service Workers (FSWs) and
supervisors at the end of each review to discuss individual cases, as well as at Grand Round sessions in
which reviewers, field staff and QSR staff discussed the reviewed cases. Following the review, regional
staff and reviewers met in a wrap-up session to discuss practice strengths and opportunities for
improvement, to identify systemic trends and to initiate planning based on review findings.
For each case reviewed4, the review team produced a narrative summary after the review was
completed. The narrative summary provides a description of the findings, explaining the reviewer’s
perspective about what seems to be working and what needs improvement. The narratives help explain
the numerical results of the review by describing the circumstances of each case.
The QSR process includes a review of records for the following items:
•
•
•
•
•
•
•
Psychological or other specialized evaluations;
School records and Individual Education Plan(s), if applicable;
Service Plan(s) or Individual Program Plan.
Court order for custody;
Family Functional Assessment;
Petition that led to custody;
Family Functional Assessment;
The majority of information is collected through structured interviews with the following:
Child, if age appropriate;
Parent(s);
Caregiver (resource parent or direct care staff in a facility);
Family service work or case manager;
Teacher or other school representative;
4
During the review year, twelve cases that were selected for review were unable to be finalized (two were non-custodial
cases, three were custodial cases of youth adjudicated delinquent, and seven were members of the Brian A. class). In four of
these cases, reviewers were unable to rate the case because key respondents did not participate in the interview process. In
the remaining eight cases, the case was reviewed, feedback provided, and preliminary ratings produced, but a case narrative
was not produced so the Quality Assurance process could not be completed on the cases.
50
Appendix A
Any other relevant service provider (Guardian ad Litem, therapist, etc.);
Other significant/relevant person (relative, friend, coach, etc.).
Before writing the brief narrative case summary of the case, certified reviewers apply the pertinent
information collected through the in-depth interview process to specific criterion measures or indicators
regarding the status of child and family and the adequacy of the service system functioning listed below.
Status of the Child/Family
Service System Functioning
1. Safety
1. Engagement
2. Stability
2. Teamwork and Coordination
3. Appropriate Placement
3. Ongoing Functional Assessment
4. Health/Physical Well-being
4. Long-Term View
5. Emotional/Behavioral Well-being
5. Child and Family Planning Process
6. Learning and Development
6. Plan Implementation
7. Caregiver Functioning
7. Tracking and Adjustment
8. Permanence
8. Resource Availability and Use
9. Family Functioning and Resourcefulness 9. Informal Support and Community
Involvement
10. Family Connections
10. Placement Supports
11. Satisfaction
11. Transitioning For Child and Family
The overall goal of the review is to provide valid information on what is working/not working in
practice and why. The QSR results assist key stakeholders including DCS Family Service Workers and
leadership, providers, placements, schools and juvenile courts toward improving or maintaining an
acceptable model of best practice that provides the most desirable and appropriate services to children
and their families.
Based on all the information collected in the QSR process, the results demonstrate the need for the
following priority recommendations for enhancements in the child welfare system to improve both
system functioning and outcomes for children and their families.
51
pr
o
C
Fa
m
ily
Sa
ra
l
ng
tio
n
ct
io
ns
ni
ng
tis
fa
c
ne
ct
io
ni
ar
ni
ng
ct
io
Fu
n
Fu
n
Le
eh
av
io
Co
n
m
ily
gi
ve
r
Fa
ar
e
l/
B
th
cy
ea
l
en
t
23%
26%
16%
14%
23%
40%
44%
49%
52%
35%
42%
36%
73%
75%
81%
79%
77%
78%
81%
83%
92%
94%
95%
96%
97%
97%
99%
99%
87%
89%
93%
92%
73%
73%
81%
85%
58%
63%
70%
70%
2009-2010 n=191
H
rm
an
Pl
ac
em
en
Pe
e
ilit
y
94%
98%
98%
98%
2008-2009 n=189
na
pr
ia
t
St
ab
fe
ty
2007-2008 n=196
Em
ot
io
Ap
Sa
Appendix B
Child and Family Percent Acceptable
Brian A. Cases
2010-2011 Brian A. cases n=200
52
an
ce
&
ni
ng
rts
ts
30%
32%
34%
50%
64%
59%
60%
66%
53%
48%
52%
47%
36%
38%
41%
51%
53%
74%
82%
89%
89%
92%
2010-2011 Brian A. cases n=200
sit
io
up
po
pp
or
lity
43%
31%
35%
39%
28%
34%
34%
28%
28%
31%
51%
59%
System Performance Percent Acceptable
Brian A. Cases
Tr
an
tS
n
en
t
ta
tio
st
m
Su
w
ce
ss
Av
ai
la
bi
Ad
ju
or
m
al
ur
In
f
es
o
ng
em
en
Pl
ac
em
en
R
Tr
ac
ki
Im
pl
Pr
o
Vi
e
30%
34%
40%
39%
45%
59%
2009-2010 n=191
ni
ng
-T
er
m
g
31%
38%
45%
44%
2008-2009 n=189
Pl
an
ng
t
n
in
tio
er
st
an
d
in
a
em
en
oo
rd
ga
g
2007-2008 n=196
Pl
an
C
En
Un
d
d
Lo
t&
k
ss
m
en
am
wo
r
As
se
Te
Appendix B
53
Appendix B
76.7%
Acceptable (Score of 4,5,6)
Marginally Unacceptable
(Score of 3)
8.7%
9.3%
13.2%
13.8%
15.4%
14.7%
16.5%
16.9%
17.6%
2005-2006
2007-2008
2008-2009
2009-2010
2010-2011
16.3%
74.2%
69.9%
68.5%
68.3%
Statewide Child and Family Status - Brian A
Percent of Scores Within Each Range
Poor or Adverse (Score of
1,2)
Acceptable (Score of 4,5,6)
14.4%
22.7%
26.0%
30.3%
27.0%
31.2%
32.7%
34.2%
30.5%
Marginally Unacceptable
(Score of 3)
24.0%
2005-2006
2007-2008
2008-2009
2009-2010
2010-2011
58.6%
46.1%
43.4%
39.8%
39.2%
Statewide System Performance - Brian A
Percent of Scores Within Each Range
Poor or Adverse (Score of
1,2)
The charts reflect final statewide data of all the randomly sampled Brian A. class members.
Cases reviewed as part of the “best practice” selection are not included.
54
Appendix C
Severe Abuse Targeted Analysis
As the review year progressed, it was evident in several of the regional reviews that cases involving a
Severe Abuse finding against the parents and cases where a Severe Abuse Adjudication was being
sought in the courts were often presented with multiple barriers to achieving desired outcomes. Central
Office QSR staff conducted a targeted analysis of these cases and discussed key themes with Central
Office Legal staff to identify system and practice based opportunities to strengthen practice in these
cases. A summary of findings is provided below.
90%
86%
Sa
t is
fa
ct
io
n
Le
ar
ar
ni
eg
ng
iv
er
Fu
nc
tio
Fa
ni
ng
m
ily
Fu
nc
tio
Fa
ni
m
ng
ily
C
on
ne
ct
io
ns
C
Be
ha
vi
or
al
ea
lth
ot
io
na
l/
H
Em
en
cy
Pe
rm
an
en
t
Pl
ac
em
St
ab
ilit
y
Ap
pr
op
ria
te
Sa
fe
ty
24%
35%
47%
62%
76%
95%
Child and Family Percent Acceptable
Cases Involving Severe Abuse
90%
100%
2010-2011 custodial cases involving
Severe Abuse n=21
100%
2010-2011 all Brian A. cases n=200
A clear practice challenge is Engagement with families for whom the introduction of a severe abuse
indication creates an antagonistic and mistrustful relationship with the system. In some cases, it appears
that staff took the no contact order/no reasonable efforts finding to mean that we had no further
responsibilities to communicate with families, creating barriers to positive outcomes that might have
been avoided with more information-sharing about the court process, legal status and basic
circumstances of the case (ET-18, KX-20, and SM-12). In other cases, families that had begun to work
with a Child and Family Team toward developing a meaningful assessment and plan stopped when
severe abuse or criminal charges became a possibility, sometimes on the advice of attorneys. An
opportunity exists to strengthen our practice and communication with families in this difficult situation
(UC-16, SM-03, SH-14, and UC-05). In two cases, DCS is pursuing a severe abuse finding but there is
no indicated perpetrator for the abuse. In both cases, the parents are working the permanency plan and
team members working directly with the families feel reunification is possible (MC-13 and SH-14).
55
Appendix C
2010-2011 all Brian A. cases n=200
62%
43%
ng
sit
io
Tr
an
up
po
tS
em
en
ni
rts
ts
pp
or
Su
Pl
ac
ur
es
o
or
m
al
ce
Av
Ad
ju
R
In
f
st
m
ai
la
bi
lity
en
t
n
&
ng
Tr
ac
ki
Pl
an
Im
pl
em
en
Pr
o
ni
ng
ta
tio
ce
ss
w
Vi
e
ng
Pl
an
t&
se
ss
m
en
Lo
Un
d
er
st
-T
er
m
an
d
tio
in
a
oo
rd
C
d
an
As
k
in
n
t
em
en
ga
g
En
am
wo
r
Te
g
29%
38%
43%
48%
38%
48%
62%
71%
90%
2010-2011 custodial cases involving
Severe Abuse n=21
System Performance Percent Acceptable
Cases Involving Severe Abuse
One case appears to describe the most textbook application and implementation of a severe abuse
finding. In this case, severe abuse was indicated by CPS, no reasonable efforts ruling was made, and
TPR hearing scheduled on the same day within 30 days of custody. Importantly, this was a physical
abuse case with very clear evidence and a prior incident, not something we have in most cases. This is
significantly consistent with the practice model, as the Child and Family Team developed and supported
the decision-making in this case (TV-17). In seven of the cases, parents are working the permanency
plans and some are successfully achieving reunification. In these instances, the involvement of a severe
abuse finding did not contribute to the positive outcomes seen nor create large barriers to implementing
team decisions, but was rather an additional process present in the case. The case stories do not address
any additional protective factors present based on the Commissioner’s Review process that occurs prior
to beginning unsupervised visits or reunifying in these cases, but some information about the team’s
perspective on this process was captured. In one non-custodial case, UC-NC2, the team was satisfied
with the timeliness of the Commissioner’s Review process but acknowledged that it did take some of the
team’s ability to lead decisions away. Generally, field staff perspective about the Commissioner’s
Review process is positive in that it goes relatively quickly as long as all the information is presented on
the front end. Cases involving severe abuse with reunification occurring include SH-14, UC-18, MC-13,
SM-03, KX-20, UC-16, and ET-18.
Although the Commissioner’s Review process is not seen as a barrier to timeliness when these cases
ultimately move toward reunification, there are some challenges in these cases related to the length of
time these cases move through the court system when they are headed toward TPR and adoption. The
56
Appendix C
process of adjudication of severe abuse is a court process that is (often) highly adversarial and can result
in additional hearings and appeals in addition to the adjudicatory and permanency hearings that occur in
every custodial case. In TV-11, the case is expected to be in court for several months. During the
review, DCS respondents stated to reviewers that there was information they were intentionally not
sharing among team members because they are seeking a severe abuse finding against the mother at
court. While the CPS workers and the DCS attorney are confident that this information will result in a
severe abuse finding against the mother, the resource parents, contract agency case manager, mother,
and GAL all believe the child should be able to return safely to the mother – as do the FSW and TL,
aside from knowing that the CPS worker and DCS attorney have this information that they are not
sharing. It is anticipated that whichever side prevails in the initial round of court hearings, the other will
appeal. In some of these cases, it might have been possible to secure a TPR based on other factors
presented in the case without the severe abuse process occurring, as in SC-21, ET-18, SM-08, UC-16,
SM-03, SW-07, and SH-14. In two cases involving youth, they desire contact with their parents.
Because DCS is no longer working with the parents, opportunities to help these youth develop ways to
preserve their sense of safety in these ongoing relationships were not taken up on. In one of these cases,
the youth’s well-being status is declining as a result of separation from his family (SC-11 and SM-12).
57
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
Lo
g
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
kin
tio
n
g
&
Ad
ju
st
Re
m
en
so
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
pp
Pl
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
62%
62%
72%
71%
Davidson
81%
83%
88%
System Performance Percent Acceptable
Custodial Cases
40%
35%
50%
48%
52%
48%
52%
48%
52%
67%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Em
ot
io
na
Pl
a
Pe
rm
an
ria
te
St
ab
17%
40%
36%
41%
29%
33%
61%
76%
69%
75%
67%
71%
76%
60%
53%
50%
78%
71%
69%
74%
56%
62%
94%
100%
100%
95%
95%
95%
100%
94%
100%
90%
83%
Davidson
29%
22%
28%
33%
38%
48%
48%
52%
Ap
pr
op
fe
ty
2008-2009 Davidson n=18
2009-2010 Davidson n=19
2010-2011 Davidson n=21
2010-2011 All custodial cases n=256
28%
33%
33%
28%
39%
50%
48%
52%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
58
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
Lo
g
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
kin
tio
n
g
&
Ad
ju
st
Re
m
en
so
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
pp
Pl
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
68%
68%
91%
100%
East
88%
81%
System Performance Percent Acceptable
Custodial Cases
45%
45%
56%
57%
56%
57%
50%
57%
50%
52%
45%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
38%
59%
59%
53%
50%
57%
50%
47%
47%
39%
38%
50%
72%
81%
100%
95%
100%
90%
86%
78%
100%
100%
100%
100%
95%
91%
78%
81%
84%
71%
100%
100%
95%
East
35%
33%
33%
33%
32%
43%
57%
62%
55%
57%
55%
fe
ty
2008-2009 East n=18
2009-2010 East n=21
2010-2011 East n=22
2010-2011 All custodial cases n=256
28%
27%
22%
28%
33%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
59
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
k in
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
68%
65%
84%
90%
82%
Knox
100%
System Performance Percent Acceptable
Custodial Cases
50%
55%
50%
50%
59%
59%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
10%
10%
29%
28%
27%
56%
44%
50%
41%
56%
55%
70%
75%
73%
75%
75%
73%
100%
100%
100%
100%
100%
100%
95%
90%
85%
80%
75%
68%
90%
100%
100%
100%
Knox
32%
37%
30%
35%
59%
55%
50%
40%
35%
45%
30%
30%
35%
40%
40%
59%
55%
fe
ty
2008-2009 Knox n=19
2009-2010 Knox n=20
2010-2011 Knox n=22
2010-2011 All custodial cases n=256
25%
25%
30%
30%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
60
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
kin
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
59%
55%
56%
55%
64%
61%
55%
55%
50%
40%
44%
39%
86%
78%
System Performance Percent Acceptable
Custodial Cases
Mid-Cumberland
95%
100%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
10%
29%
28%
32%
47%
41%
81%
100%
95%
70%
78%
86%
81%
100%
100%
100%
94%
86%
85%
75%
78%
86%
71%
56%
63%
59%
56%
72%
64%
55%
100%
95%
90%
Mid-Cumberland
32%
35%
39%
30%
30%
56%
59%
61%
59%
78%
fe
ty
2008-2009 Mid-Cumberland n=20
2009-2010 Mid-Cumberland n=18
2010-2011 Mid-Cumberland n=22
2010-2011 All custodial cases n=256
35%
33%
41%
25%
40%
50%
55%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
61
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
kin
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
24%
43%
48%
57%
47%
55%
62%
80%
84%
78%
95%
System Performance Percent Acceptable
Custodial Cases
44%
53%
65%
Northeast
57%
52%
52%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Em
ot
io
na
Pl
a
Pe
rm
an
ria
te
St
ab
12%
100%
100%
95%
91%
100%
95%
90%
94%
91%
86%
76%
81%
79%
76%
70%
62%
55%
58%
50%
42%
35%
40%
39%
33%
82%
83%
76%
71%
71%
100%
91%
100%
Northeast
43%
41%
52%
48%
41%
38%
35%
61%
Ap
pr
op
fe
ty
2008-2009 Northeast n=17
2009-2010 Northeast n=21
2010-2011 Northeast n=21
2010-2011 All custodial cases n=256
43%
38%
35%
48%
41%
53%
52%
52%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
62
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
kin
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
15%
20%
45%
48%
62%
71%
65%
57%
67%
57%
62%
67%
81%
81%
System Performance Percent Acceptable
Custodial Cases
Northwest
100%
94%
89%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
19%
13%
10%
30%
40%
44%
43%
80%
86%
71%
95%
100%
94%
89%
90%
100%
100%
100%
90%
95%
90%
85%
81%
80%
76%
71%
71%
65%
61%
60%
95%
100%
95%
Northwest
35%
33%
35%
35%
38%
52%
67%
67%
71%
fe
ty
2008-2009 Northwest n=20
2009-2010 Northwest n=21
2010-2011 Northwest n=21
2010-2011 All custodial cases n=256
30%
33%
50%
43%
40%
45%
38%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
63
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
k in
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
37%
33%
37%
38%
45%
42%
67%
62%
50%
58%
System Performance Percent Acceptable
Custodial Cases
Shelby
94%
100%
100%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
24%
15%
36%
38%
65%
100%
95%
100%
79%
76%
81%
88%
88%
84%
90%
85%
79%
86%
70%
63%
71%
57%
60%
41%
47%
53%
37%
42%
100%
100%
95%
100%
100%
Shelby
21%
26%
26%
30%
26%
29%
30%
26%
38%
25%
26%
32%
24%
48%
fe
ty
2008-2009 Shelby n=20
2009-2010 Shelby n=19
2010-2011 Shelby n=21
2010-2011 All custodial cases n=256
20%
30%
26%
29%
20%
25%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
64
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
k in
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
81%
87%
90%
Smoky Mountain
50%
55%
58%
64%
65%
System Performance Percent Acceptable
Custodial Cases
27%
33%
41%
42%
45%
50%
45%
41%
35%
32%
29%
26%
21%
36%
45%
41%
50%
55%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
fe
ty
9%
6%
31%
26%
27%
46%
40%
43%
43%
59%
65%
65%
58%
64%
100%
94%
93%
90%
91%
94%
100%
95%
89%
86%
76%
79%
78%
79%
77%
76%
100%
100%
100%
2008-2009 Smoky Mountain n=17
2009-2010 Smoky Mountain n=19
2010-2011 Smoky Mountain n=22
2010-2011 All custodial cases n=256
24%
21%
26%
21%
41%
41%
42%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
Smoky Mountain
65
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
k in
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
75%
100%
94%
South Central
71%
70%
70%
80%
System Performance Percent Acceptable
Custodial Cases
35%
39%
47%
55%
75%
70%
65%
60%
75%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
15%
26%
38%
70%
68%
64%
62%
58%
95%
100%
100%
95%
89%
95%
85%
100%
100%
94%
90%
88%
95%
80%
74%
74%
68%
75%
62%
53%
45%
55%
95%
100%
100%
South Central
42%
45%
42%
40%
42%
40%
37%
42%
65%
65%
80%
fe
ty
2008-2009 South Central n=20
2009-2010 South Central n=19
2010-2011 South Central n=20
2010-2011 All custodial cases n=256
30%
40%
32%
42%
55%
47%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
66
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
k in
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
35%
60%
70%
74%
75%
Southwest
100%
93%
86%
System Performance Percent Acceptable
Custodial Cases
44%
47%
53%
47%
47%
70%
75%
75%
75%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
6%
31%
26%
45%
45%
94%
95%
100%
89%
95%
88%
95%
90%
82%
86%
94%
100%
71%
79%
80%
72%
80%
76%
68%
62%
56%
50%
40%
44%
35%
94%
100%
95%
Southwest
29%
24%
47%
42%
50%
35%
47%
40%
53%
53%
63%
fe
ty
2008-2009 Southwest n=17
2009-2010 Southwest n=19
2010-2011 Southwest n=20
2010-2011 All custodial cases n=256
24%
18%
35%
41%
53%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
67
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
kin
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
37%
97%
90%
100%
86%
Tennessee Valley
67%
63%
58%
64%
63%
55%
55%
50%
59%
59%
System Performance Percent Acceptable
Custodial Cases
37%
31%
34%
37%
34%
50%
55%
68%
73%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
fe
ty
18%
18%
34%
41%
60%
52%
55%
60%
50%
97%
82%
74%
86%
95%
86%
87%
84%
80%
75%
100%
97%
100%
89%
82%
95%
77%
71%
66%
66%
61%
97%
89%
100%
2008-2009 Hamilton and Southeast n=38
2009-2010 Hamilton and Southeast n=38
2010-2011 Tennessee Valley n=22
2010-2011 All custodial cases n=256
32%
26%
55%
55%
53%
45%
37%
39%
39%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
Tennessee Valley
68
w
or
k
an
d
En
ga
g
em
en
t
Co
or
di
en
na
t&
tio
n
Un
de
rs
ta
nd
in
g
Lo
ng
-T
er
m
Vi
Pl
ew
an
ni
ng
Pr
oc
Pl
es
an
s
Im
pl
em
Tr
en
ac
ta
kin
tio
n
g
&
Ad
ju
st
Re
m
so
en
ur
t
ce
Av
ai
la
bi
In
lity
fo
rm
al
Su
Pl
pp
ac
or
em
ts
en
tS
up
po
rts
Tr
an
sit
io
ni
ng
As
se
ss
m
Te
am
11%
11%
27%
21%
78%
86%
87%
Upper Cumberland
39%
50%
73%
System Performance Percent Acceptable
Custodial Cases
39%
59%
56%
58%
50%
50%
45%
41%
39%
33%
26%
33%
36%
33%
41%
39%
50%
50%
44%
C
ive
r
Fa
m
ily
H
th
ne
ct
io
ns
ni
ng
ni
ng
Sa
tis
fa
ct
io
n
Co
n
Fu
nc
t io
Fu
nc
tio
Le
ar
ni
ng
ra
l
ea
l
en
cy
ce
m
en
t
ilit
y
l/
Be
ha
vi
o
Fa
m
ily
ar
eg
Pl
a
St
ab
Pe
rm
an
ria
te
Em
ot
io
na
Ap
pr
op
fe
ty
12%
31%
28%
16%
23%
45%
41%
54%
63%
67%
93%
89%
90%
82%
83%
78%
79%
77%
82%
81%
81%
100%
95%
95%
83%
84%
91%
72%
79%
73%
100%
100%
95%
2008-2009 Upper Cumberland n=18
2009-2010 Upper Cumberland n=19
2010-2011 Upper Cumberland n=22
2010-2011 All custodial cases n=256
16%
21%
16%
11%
Sa
Appendix D
Child and Family Percent Acceptable
Custodial Cases
Upper Cumberland
69
Appendix E
Critical Issues in the Statewide Custody Population – CPORT/QSR Evaluation Results
Critical issues are defined as conditions children and families have experienced in their environment that
contribute to the risk of children entering or remaining in custody.
Data below are reflective of the population of children in custody of the Department of Children’s
Services. At the beginning of 2010-2011, Tennessee had approximately 7200 children in custody. To
evaluate critical issues for a representative sample of children served by the state, the sample size was
predetermined in order that the results of the case review process would be statistically significant at the
85% level of confidence with +/- 15 % accuracy for each regional sample. The number of cases
reviewed statewide is designed to be statistically significant at the 99% level of confidence with +/- 10
% accuracy for the state sample. These calculations indicate that a sample size of 264 children for the
regional distribution of results and 163 for the statewide distribution of results would be sufficient in
reflecting the target population. These data results below are reflective of the population of children
(approximately 7,200) in the custody of DCS.In the following charts, percentages indicate the cases in
which the identified issue was present.
70
Appendix E
71
Appendix E
72
Appendix F
Participating Reviewers
Tennessee Commission on Children and Youth
Marietta Backus
Cyndy Banks
Sumita Bannerjee
Beverly Bell
Kimberly Bishop
Peggy Carter
Steve Chester
Susan Cope
Anne Marie Dudas
Jennifer Hargis
Peggy Haynes
Martie Hendon
Pam Kirkpatrick
Frances Lewis
Rosamond McLeod
Lisa Rodriguez
Cheryl Sahlin
Deborah Stafford
April Swoner
Pat Wade
Zanira Whitfield
Tennessee Center for Child Welfare
Jason Ball
Liz Beach-Cutshaw
Jill Black
Sirena Bragg
Tonja Brown
Jennifer Buhl
Twyla Correa
Carolyn Crane
Joye Duvall
Stephanie Ellis
Tameika Foreman
Sherry Haines
Kim Harris
Linda Heckathorn
Cindy Hensley
Kellie Hilker
Hope Hopkins
Ramona Huggins
Doretha Johnson
Chris Keller
Nancy King
Carolyn Kiser
Tamika Lott
Freda Martin
Laura Mathews
Brandi McAninch
Emily McCutcheon
Michelle McGruder
Kim Morris
Landra Orr
Kristi Paling
Kerry Patterson
Janel Seeley
Shannon Starks
Ed Stotts
Cecilia Teal
Jennifer Williams
Lictoria Woods
Davidson County Juvenile Court
Mary Ann Bell
Janet Neilson
73
Appendix F
Court Appointed Special Advocates (CASA)
Suzanne Harrison
Vanderbilt Child and Adolescent Needs and Strengths (CANS) Consultants
April Anderson
Jennifer Conyer
Chris Harris
Sonya Miller
Melissa Tanner
Yolanda Woodard
Department of Children’s Services
Sherry Allen
Sikitia Allen
Andrea Baker
Chris Baker
Sharon Battle
Loretta Beard
Kathy Bell
Daphne Billingsley
LeeAnn Brabson
Antonio Bratcher
Tracy Brignac
Carrie Brock
Bret Brooks
Charity Brown
Pametria Brown
Sally Brown
Lia Buckner
Sharon Burrus
LaNae Cannon
Tandra Carter
Amy Cassell
Laura Clabo
Stephanie Coleman
Michelle Collins
Correnthia Copeland
Linda Copeland
Tyran Copeland
Gwen Covington
Regina Cox
John Davis
Tracy Davis
Earla Denney
Tammy Dixon
Jason Dockery
Allison Downs
Andrew Duffel
Mary Beth Duke
Jana Elkins
Tiffany Ellis
Cynthia Ellison
Becky Ervin
Cheryl Fergerson
James Field
Amy Ford-Hulen
Carla Forsyth
Michelle Foshee
John Gaeto
Lakeisha Gatewood
Candi Glasscock
Tracey Golden
Tiwanna Gorrell
Tessa Gregg
Vickie Green
Chris Griffy
Dave Hall
Pam Harr
Elane Hart
Cha’Dawn Hayes
Christina Headrick
Rebecca Hendrich
Pam Hickman-Winters
Connor Hoke
Sandra Holder
Elaine Hong
James Horine
Quincy Hughes
74
Appendix F
Marie Hurst
Raymond Jenkins
Amanda Jones
Neil Jones
Petrina Jones-Jesz
Priscilla Juchemich
Beth Kasch
Pam Keene
Kathy King
Karen Kirkwood
Mia Lester
Donna Lorhorn
Neil Lowe
Suzanne Lowe
Tiffany Lusby-Spivey
Kay Luttrell
Lea Mandle
Barbara Maners
Wanda Martin
Brigette Massey
Reba McBride
Marsha McClure
Shelby McClurkan
Carrie McCrary
Susan Mee
Lisa Merritt
Todd Mink
Conni Mitchem
Frank Mix
Julia Mobiglia
Chris Moser
Connie Murphy
Tony Nease
Valeria Neumann
Beverly Norment
Reed O’Bear
Amy O’Neill
Deb Owens
Crystal Parker
Jamie Perkins
Jemeca Pointer
Sherry Porter
Dwane Powers
Cora Proctor
Beverly Quinn
Cheri Richards
Jennifer Ricker
Mary Rivers
Kizzy Rogers
Morgan Rogers
Anne Ross
Sevara Sawyers
Amanda Schrock
Jason Sharif
Dava Silva
Alisha Singley
Rosie Skinner
John Smith
Terika Sneed
Nikki Stamm
Jennifer Stamper
Calbirtha Stewart
Jackie Stewart
Delsia Stokes
Misty Street
Rachel Sullivan
Cynthia Suttles
Barbara Taylor
Clifton Taylor
Latricia Taylor
Kristy Troutman
Carla Tucker
Cathleen Vaughn
Jason Walker
Potocha Walker
Carol Waters
Roger Webster
Rebecca Whiteside
Jim Wilkins
Wendy Williamson
Holly Wilson
Cheryl Woodard
Christina Wooden
Kim Wright
Jennifer Yarbrough
Dierdre Young
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