A lack of supervision, documentation and timely assessment of certain Wilkes Department of Social Services (DSS) child protective services cases are cited in a report released Thursday by the N.C. Department of Health and Human Services.
The report said the findings resulted from a review of a sample of Wilkes DSS cases in the first week in March. It said Wilkes DSS must develop a plan to address issues identified and that state Division of Social Services officials would assist by providing oversight, technical aid and training and conduct a follow up review within six months to determine progress toward addressing the findings.
“DHHS staff conducted a thorough review of the Wilkes County Child Welfare Program, focusing on child protective services, and we identified several areas needing improvement and deficiencies that must be addressed,” said Wayne Black, Director of the DHHS’ Division of Social Services.
“DHHS takes the safety and well-being of every child very seriously, and we will provide the technical assistance necessary to ensure that the Wilkes County Child Welfare Program is strengthened,” said Black.
Wilkes DSS Director Bill Sebastian indicated that a response to the report from Wilkes DSS would be provided later.
Case in Yadkin County
The report said that on Feb. 19, state DSS became aware of a case in which foster children were victimized while in a placement made through Wilkes DSS.
This apparently was the case in which Wilkes DSS removed two children from their Wilkes home after their father was convicted of sex offenses in Wilkes Superior Court and put them in a Yadkin County home where two other adults were subsequently charged with committing sex offenses against the two juveniles.
Questions were raised in the media about how Wilkes DSS handled the case.
The report said that on Feb. 21 and 24, state DSS staff conducted a preliminary assessment of Wilkes DSS to determine program areas requiring further in depth review. It said this included reviewing the entire case record of the foster children in the case they became aware of on Feb. 19.
The report didn’t include any findings on any foster care cases.
Since the review focused on a targeted sample of cases with issues identified as concerns, the report said, “the observations/findings are not necessarily a reflection of the Wilkes County DSS’ child welfare program performance.”
Lack of staffing
The review found that Wilkes DSS had a 39.29 percent vacancy rate among child welfare social workers, compared to 22.49 percent for North Carolina.
It found that Wilkes DSS was out of compliance with the required ratio of one supervisor to five social workers. For example, it found that two Wilkes DSS, child protective services supervisors are responsible for supervising 11 and eight positions, respectively and two foster care supervisors supervise six and eight positions respectively.
The report recommended that Wilkes DSS fill a long vacant child protective services position. It also recommended that Wilkes DSS create a new child welfare supervisor position to comply with the policy for supervisor to staff ratio.
The report said data submitted by Wilkes DSS in late January indicated a large number of child protective services assessments weren’t resolved in a reasonable time in 2013. DSS social workers do assessments when child abuse or neglect is reported.
The report said the large number of these cases open for unreasonably long periods is largely “due to the lack of leadership, supervision and timely assessments ending with accurate and well informed case decisions.”
The review, conducted by five state DSS staff members, found that in 2013 Wilkes DSS had an average of 219 assessment cases open at the end of each month and accepted an average of 62 new cases each month.
Due to this assessment, state DSS developed a plan to conduct a broader review of Wilkes child protective services cases and their management.
The report said the case review included a sample of 28 child protective services cases, including 17 assessment cases open over 45 days to determine source of delays in decision making, three “in home services cases” open over 180 days and eight reports that Wilkes DSS determined didn’t meet criteria for assessment.
The evaluation included examining records for intake decisions, initiation of assessments, safety planning, home visits, face-to-face contacts, supervision and decision-making. It also included examining records of interviews with victim children, parents and collateral contacts and required notices to people who reported cases, law enforcement and the district attorney’s office.
The report said that according to Wilkes DSS management, child protective services and foster care “lead supervisors” were designated to mitigate the supervision deficiency. “However, these designations do not have any apparent significance in daily operations and offer no additional accountability or coordination for program or case outcomes,” the report said.
It said four child welfare supervisors report to a program administrator who is also responsible for supervising all line supervisors in the agency, resulting in a ratio of one program administrator to 12 supervisors.
The report said there is no clear coordination of activities between supervisors, resulting in diverse decision-making and disagreements on management of cases.
“Wilkes DSS has an automated system for tracking cases, but it is not used since information is not kept up to date by social workers or supervisors. This results in incomplete and inaccurate tracking data that is unreliable for decision making,” the report concluded.
It also recommended that Wilkes DSS create a plan to increase accountability of supervisors and social workers, which should identify leadership, including Sebastian, to track process and outcome data to assure compliance with law, rule, policy and best practices.
The report said Wilkes DSS management and supervisors “shall evaluate use of the county automated case tracking system to remain informed on case management activities and workloads. This includes developing a means to hold social workers and supervisors accountable for timely entry of information.”
The report also said state DSS will provide technical assistance and support to establish processes and protocols for supervision and the management of cases.
As “evidenced by the inconsistency in record organization among records reviewed and the wide range of styles in documentation among social workers,” the report said, no one is held accountable for using the written, file organization protocol at Wilkes DSS..
The report said state DSS staff who conducted the review had difficulty finding critical information in records due partly to illegible handwritten notes.
“There was insufficient documentation in most records to determine if decisions regarding child safety and well being were accurate. Required documentation tools, most conspicuously the ‘Structured Decision Making Tool’ required at the conclusion of CPS (child protective services) assessments, were absent among case documentation,” the report stated.
The report said Wilkes DSS must develop and implement a plan for holding social workers and supervisors accountable for maintaining accurate and timely documentation in case records and this plan must begin with supervisors no longer signing off on incomplete records. It said supervisors must immediately stop approving closure of assessments when structured decision making tools aren’t completed.
The report said state DSS will provide technical assistance to coach supervisors in identifying and reviewing basic documentation.
Quality assurance reviews
The review found that Wilkes DSS has no systematic means for supervisors or management to review records, data or outcomes. “The lack of any visible review of case records has resulted in many poorly documented cases and cases without any activity for periods of time,” the report concluded.
The report said Wilkes DSS needs a regular system of quality assurance reviews to ensure adherence to federal and state laws and policies resulting in positive outcomes for children and families.
It said state DSS will provide technical help to develop a model for conducting quality assurance case reviews.
The structured child protective services intake report required by the state found in all Wilkes DSS records reviewed wasn’t compete, so state DSS staff who conducted the review couldn’t determine if screening decisions were accurate. For those reports in which the reporter was known, notices were sent timely.
It was recommended that Wilkes DSS social workers who receive and screen child protective services reports be held accountable for using and completing the structured intake report to document interviews.
The report said Wilkes DSS supervisors reviewing child protective services intake reports as part of a two-party review must not sign off on reports until the structured intake report is thoroughly completed, including calling the reporter for more information.
The report said Wilkes DSS will establish a way for management to systematically review intake documentation and decisions.
Delayed assessment decisions
The report noted that when reports of suspected child abuse, neglect or dependency are received, the county DSS director is charged with conducting a prompt and thorough assessment of allegations in accordance with statutes.
Although statutes don’t stipulate a time frame for completing assessments, state DSS provides guidance on time frames for their completion “and decisions must only be made when all relevant information is gathered and processed to make an informed decision,” the report said.
The report said state DSS chose 17 Wilkes child protective services cases that didn’t comply with policy guidelines to determine why assessment decisions in these types of cases were delayed.
Among these 17 assessments, 17 were left open from 62 to 450 days, five weren’t substantiated needing services and were closed within the last six months after being open 34 to 334 days and three resulted in child protective services, in home services due to a substantiated or in need of services finding.
The report said assessment cases were left open for long periods with no contacts and no documentation of the reason for no contact.
“There was little documentation of supervisory oversight other then a signature at time of closure. In some cases when there was documentation of supervisory direction, it was not followed by the social worker and the supervisor had no means to know the task was not completed,” the report said.
“The most significant contributor to unreasonable delays in case decisions identified by the reviewers appeared to be a lack of supervisor time and oversight.”
In 13 of the 17 assessments reviewed, Wilkes DSS didn’t initiate the assessment within the response time set at the time the report was screened for assessment. “These delays in initiation were not supported in documentation,” the report said.
The report continued,
“Ongoing visits and contacts with families to assure safety of the children throughout the assessment process was sufficient in only 11.8 percent of the assessments;
“All adults living in the child’s household were seen and interviewed in 35.3 percent of the assessments;
“Criminal checks on all adults in the home were completed in 35.3 pecent of the assessments;
“All allegations in the original report were discussed with families in 52.9 percent of the assessments.”
The report said the structured documentation instrument for assessments required by policy weren’t utilized.
In 58 percent of the closed assessments, reviewers couldn’t determine if decisions were accurate due to insufficient information in case documentation. Two of the 12 closed cases weren’t approved by a supervisor.
Collateral contacts that could have critical information were not contacted in over half the cases. Central Registry checks were not completed on all cases as required.
The report said Wilkes DSS supervisors must immediately cease approving closure of assessments when the structured documentation instrument isn’t completed.
It said Wilkes DSS should develop and implement a case tracking log with all documented tasks for assessments, with date of completion maintained by social workers and reviewed by supervisors.
It said Wilkes DSS should use a supervisory review tool for staffing cases with social workers and implement a process for conducting case decision staffings when all required tasks for a thorough assessment are completed. It said state DSS will provide technical assistance for this.
In home services
In home services are used in child protective services cases when an assessment finds that a child is at risk of abuse or neglect. The goal of case management services, guided by a case plan developed with the family, are to prevent more maltreatment and also prevent foster care placement.
“These services are designed to be intense and time limited. Cases in which the conditions leading to the risk of maltreatment have not been significantly reduced or ameliorated within 90 days should be reviewed for possible court intervention,” the report said.
Among three Wilkes DSS in home services cases reviewed, the report said, two were still open after 10 to 14 months and the third was closed within six weeks of the start of in home services due to the Wilkes DSS assuming custody of the child involved.
The report said the review found “a significant lack of documentation or organization in the records,” with no documentation of services to the family, no current case plans as required by state and federal policy and no documented engagement of the family in case planning and development process.
“The lack of case plans to clearly chart case activities and goals resulted in social workers spending more time reacting to crises rather than successfully resolving risks to children and preventing foster care placements,” the report said.
“There was a significant lack of face to face contacts with families or anyone else connected with the families to assure the child’s safety for many months at a time. Child and Family Team meetings, the forum through which case plans are developed with the family and their support system according to state policy, were not utilized.”
The report said that if a safety resource placement was used for a child, social workers didn’t see or screen all adults where the children were staying. It said there was no indication of supervisory or management oversight in the cases.
The report said Wilkes DSS must immediately review the status of all open in home cases to determine the risk to the children in those cases.
It also said Wilkes DSS must:
• establish regular meeting times between social workers and supervisors to provide oversight on the cases and the recommendations/activities;
• develop a plan for regular case staffing on any in home cases open for 90 days or more, preferably with a child welfare attorney, to consider whether court oversight is required for case progress;
• develop and implement use of a case tracking tool to assure regular contacts that supervisors would review weekly;
• utilize a quality assurance system to ensure social worker and supervisor accountability in management of in home cases, including a feedback loop to management and supervisors on review outcomes.
The report said state DSS would provide technical assistance to provide guidance and consultation in the review of in home cases, develop the case tracking tool, develop and implement a plan for regular supervisory conferences with in home service workers and provide support to maintain the conferences and provide consultation and support in staffing cases open more than 90 days.