October 22, 2018
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DHHS tried to cut back on the number of child abuse cases where it intervened

Contributed photo | BDN
Contributed photo | BDN
Marissa Kennedy steps on the bus for the first day of kindergarten in New Windsor, New York, several years ago. The 10-year-old was killed in late February, allegedly beaten by her stepfather and mother in their Stockton Springs home.

Maine’s child welfare program last spring changed how it handles reports of suspected child abuse and neglect, with a goal of reducing the number of cases that cause state Child Protective Services workers to intervene.

Last May, workers at the state’s child abuse reporting hotline who make preliminary recommendations on whether caseworkers should follow up with families started using a tool called Structured Decision Making. Child welfare agencies across the country use it to ensure their workers make consistent decisions about which cases they take on, and to make sure caseworkers intervene when children are in greatest danger.

In Maine, the Department of Health and Human Services started using the tool to restrict child protective workers’ caseloads to the cases in which the agency had a “legal mandate” to intervene. The department also started using the tool as it sought to reduce the number of children in foster care.

The move has prompted concerns among social workers and others who regularly report suspected abuse to the state that Child Protective Services workers are missing credible reports of parents or caregivers abusing children.

Structured Decision Making and tools like it “can be very useful,” said Francine Garland Stark, executive director of the Maine Coalition to End Domestic Violence, which employs liaisons who work with Child Protective Services on cases that involve domestic violence. “But if part of the reason we’re using them is to pick which cases to open because of our personnel capacity, then what we’re using these assessment tools for is choosing who not to serve as opposed to figuring out the level of service.”

Child Protective Services has come under scrutiny in recent weeks following the deaths of 10-year-old Marissa Kennedy in Stockton Springs and 4-year-old Kendall Chick in Wiscasset, allegedly at the hands of their caregivers. Both families had at least some involvement with Child Protective Services, according to news reports, prompting questions about where the state’s system for protecting children in danger faltered.

It’s not yet clear if or how Structured Decision Making affected DHHS’ response to either case, as the department hasn’t released relevant details. But as department officials explained it last year to members of the state’s Child Welfare Advisory Panel, their goal with the new system was to limit the kinds of cases that made their way to Child Protective Services workers.

DHHS’ “door is wide open and families are being served inconsistently,” Bobbi Johnson, the state’s associate director of child welfare services, told the advisory panel at its June 2, 2017, meeting, according to the panel’s meeting minutes.

An outside assessment of Child Protective Services by the firm Hornby Zeller had concluded that DHHS “was serving families who don’t meet the threshold for the law for child welfare intervention,” Johnson told the Child Welfare Advisory Panel.

“The Department doesn’t want to miss families that are in need of intervention but the Department doesn’t want to be serving families that don’t need intervention,” she added, according to the minutes. Johnson also talked about “balancing State intervention and parents’ rights and responsibilities” during the meeting, the minutes show.

A DHHS spokeswoman, Emily Spencer, said in an email that Structured Decision Making “was implemented to increase consistency and efficiency in child welfare responses” and that child protective intake workers use it “to follow Maine’s statute and child welfare screening policy along with their professional judgment.” She didn’t answer a question about how the system has affected the rates of abuse reports subsequently referred to Child Protective Services investigators and caseworkers.

The tool gives intake workers a variety of factors to ask about to help them evaluate the level of danger to the children — such as whether abuse has already taken place or whether there’s drug use in the home — and determine whether state protective workers should intervene immediately, or whether a less intensive intervention is appropriate.

While the idea behind using the tool is to accurately evaluate the level of risk to children, some reports of suspected child abuse and neglect that would have normally prompted child welfare investigations are no longer causing the state to intervene, said Mark Moran, family service and support team coordinator at Eastern Maine Medical Center in Bangor.

“I am concerned that [DHHS], in their admirable effort to improve consistency and focus limited resources on the areas in which they are most needed, is missing some ‘false negatives’ — that is, reports that are deemed inappropriate [by DHHS] but are really reports that should be assigned for investigation,” said Moran, a licensed social worker and former Child Protective Services investigator.

Moran said he and his team of social workers have noticed this change recently when they’ve made reports of suspected child abuse and neglect to DHHS. In some cases, the department assigns reports to “alternative response” workers that previously would have gone to Child Protective Services for an investigation. Alternative response workers are from private organizations across the state, and work with families where children appear to be at low or moderate risk of being abused or neglected. Unlike state child protective workers, alternative response workers can’t file petitions in court to remove children from unsafe houses. Whether parents engage with alternative response services is voluntary.

In other cases where the state previously would have intervened, Moran said, there’s no follow-up by the state — whether from alternative response workers or DHHS.

“In my mind, that is the most dangerous area of this practice change,” he said. “If a report ultimately becomes a false positive, then a family was inconvenienced or perhaps there was unwarranted government intrusion into the family’s business. Not ideal of course. But if a report ultimately is a false negative, that means a kid who was in need of Child Protective Services intervention didn’t get it, and so the abuse or neglect of that child continues.”

Structured Decision Making is designed to help intake workers make consistent decisions about which cases involving potential child abuse or neglect to refer to caseworkers for investigations, which to recommend for other sorts of family services, and which to ignore. Another suite of tools from the developer, the Wisconsin-based National Council on Crime and Delinquency, helps caseworkers in the field decide on the appropriate course of action for a family under investigation.

Structured Decision Making is well tested, and it can be valuable as part of workers’ decision-making process, said Pamela Day, a former director of child welfare services and standards at the Child Welfare League of America. However, it has its limits, she said.

“The tool has to be a guide. No one suggests that the tool should be determinative,” said Day, who lives in Portland. Child protective workers “have to have reasonable caseloads, they have to have good training, and then they need to have adequate supervision. That really means that the supervisors have a very small number of workers that they’re paying attention to.”

Day questioned the premise of using the new protocol with a goal of reducing the number of cases referred to child protective workers for investigations. “The primary responsibility they have is to ensure that they are identifying children and families who have the greatest need,” she said.

In addition, Day said, child welfare agencies that adopt the tool should adopt it for all aspects of Child Protective Services, not just one. DHHS currently has it in place only for intake workers, said Christine Alberi, Maine’s child welfare ombudsman.

It’s not yet clear if Structured Decision Making is resulting in fewer cases for the state’s Child Protective Services workers to investigate. Tom Farkas, a spokesman for the Maine State Employees Association, said child protective workers — whom the association represents — have recently seen their caseloads shrink. However, the number of Child Protective Services investigations had generally been on the rise through 2016, according to published DHHS statistics.

The available statistics don’t cover the period when Structured Decision Making has been in effect.

The number of cases DHHS has assigned to alternative response — rather than assigned to a state caseworker with the ability to pursue court action to remove a child from an unsafe home — had also been on the rise in recent years, well before the state implemented Structured Decision Making, DHHS statistics show. Alternative response was also a popular option during Gov. John Baldacci’s administration, the statistics show.

Structured Decision Making is a proprietary tool. In 2016, according to contract documents, Maine DHHS paid $123,000 to the National Council on Crime and Delinquency for the rights to use the tool and for help from the council’s staff in implementing it for intake. The state has paid the council another $399,000 this year — for a contract that runs until June 30 — for the rights to use the tool during the assessment stage, when child protective workers are trying to determine whether abuse and neglect reports are true and decide whether to pursue court action to have children separated from their parents.

Maine DHHS hasn’t released much information about how it’s using Structured Decision Making, including the information intake workers need to make judgments about next steps. That has some who make regular abuse reports to DHHS concerned.

Having that information “could impact our practice in regards to what information we should be homing in on and getting more detailed information about, which ultimately could impact whether DHHS intervenes or not,” Michal Wagner, a social worker at Eastern Maine Medical Center, wrote in an email.

As DHHS intake workers became used to Structured Decision Making last summer, they apparently were still referring too many cases to child protective caseworkers.

Johnson, DHHS’ associate director of child welfare services, told the Maine Child Welfare Advisory Panel at an Oct. 6, 2017, meeting that the National Council on Crime and Delinquency had reviewed intake workers’ decisions in a number of cases.

“There were some reports that were screened in that NCCD felt should be screened out when using the tool,” Johnson told panel members, according to the meeting minutes. “Change is hard and the intake program is risk aversive.”

In some cases over time, the department likely has overstepped its legal mandate and had Child Protective Services intervene in cases where it shouldn’t have, said Destie Hohman Sprague, associate director of the Maine Coalition Against Sexual Assault. For example, when DHHS receives a report of suspected sexual abuse of a child by someone other than the child’s parents or caregivers, she said, “that’s a law enforcement issue. That’s not a CPS issue.”

The stakes are high with abuse and neglect cases, which makes it concerning when DHHS wants to limit its intervention, said Moran, the family service and support team coordinator at EMMC.

“If we, as a society, have to tolerate a few more false positives to minimize the false negatives, I think the majority of folks in the community would accept that,” he wrote, “especially considering that in some of the cases where abuse/neglect continues, kids die.”

Maine Focus is a journalism and community engagement initiative at the Bangor Daily News. Questions? Write to mainefocus@bangordailynews.com.

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