Annual Progress of Child Welfare Continuum of Services

This section describes programs and services which support a continuumof services within Missouri’s Child Welfare arena. Each program write-upprovides, when applicable, supporting change evidence from the past year’s Annual Service Plan Review (ASPR). Regardless if programs are served bypublic or private entities, Missouri strives for a seamless transitioningprocess from one program to another. Strong partnerships assist in the transitioningprocess.

The primary purpose of the Child and Family Services Plan (CFSP) is toreview the integration of programs serving children and families and tomake sure the continuum of services is adequate to meet the needs of thoseserved. From the local level to the state, messages are proclaimed robustlyand continually that everyone must work together to help families in need.From prevention, protection and permanency, Missouri Children’s Divisionstrives to continually evaluate our programs and services to advance thequality of our overall child welfare system.

Attachment A is an at-a-glance look of Missouri’s child welfare case managementflow.

  1. Protection

    Child Protective Services (CPS) is a program mandated for the protection of children alleged to be abused and neglected. This program provides specialized services seeking to prevent abuse and neglect of children. The CPS program receives, screens and investigates allegations of child abuse and neglect, performs assessments of child safety, assesses the imminent risk of harm to the children and evaluates conditions which support or refute the alleged abuse or neglect and need for emergency intervention.

    The purposes of Missouri’s CPS program are:

    • To protect the health, safety, and welfare of children by encouraging the reporting of suspected child abuse and neglect
    • To assure that appropriate protective services are provided to abused and neglected children and their families and to protect children from further harm
    • To provide support, counseling, and other services to children and their families to ameliorate the effects of child abuse and neglect
    • To promote the well being of the child in his or her home setting, wherever possible, or in another safe and stable placement

    This program provides services designed to stabilize a family in crisis and to preserve the family unit by reducing safety and risk factors. It provides an array of services including:

    • operating a single, statewide toll-free telephone number for receiving child abuse/neglect (CA/N) reports
    • conducting CA/N investigations, family assessments and preventive services screenings
    • providing newborn crisis assessment and services
    • providing background screening checks on current or prospective employees and volunteers for children/youth serving agencies
    • Healthy Children and Youth Program
    • preventive and protective child care services
    • Family-Centered Services

    Child Abuse and Neglect Hotline Unit

    The Missouri statute specifically charges the Children’s Division (CD) with the responsibility of operating a single, statewide toll-free telephone number at all times for receiving reports of child abuse and neglect (CA/N). All hotline calls are screened, assessed, and classified by Children’s Service Workers, who meet the same job qualifications as CD field investigators.

    Hotline workers use a structured-decision-making Protocol tool for conducting interviews, designed to assure for consistency and objectivity. This screening tool incorporates decision trees for classifying response time (3 hour, 24 hour, or 72 hour) and track assignment (investigation or family assessment track) on CA/N reports.

    The hotline received 126,825 calls in 2008. Administrative functions accounted for 20,994 calls; of the remaining 105,831 calls, 52% were classified as CA/N reports, 33% as non-CA/N referrals (for appropriate CD intervention or referral to another agency), and 15% as "documented" calls that were not forwarded to a CD field office.

    Hotline calls in 2007 were comparable with a total of 131,060 calls. Administrative functions accounted for 23,175 calls; of the remaining 107,885 calls, 54% were classified as CA/N reports, 31% as referrals, and 15% as "documented" calls.

    The hotline automated system is SACWIS compliant and was designed for simultaneous data entry of call information during the telephone interview.

    The hotline utilizes Call Management System technology to provide optimum coverage and customer service. Real-time call data is continuously available to both workers and supervisors. During 2008, hotline staff answered 94 % of calls offered and gave an average of 314 busy signals per month. During 2007, hotline staff answered 93% of calls offered and gave an average of 226 busy signals per month.

    In 2008, the outcomes of 5244 hotline peer record reviews, confirmed that hotline workers continue to make accurate and consistent call classifications. Results on six measures listed below ranged from 98%-100% accuracy for calendar year 2008.

    2008 CANHU PRR Results Q1 Q2 Q3 Q4 Year
    Was the answer to ENTRY question #11 (type of abuse and neglect) summarized clearly? 99% 99% 99% 100% 99%
    Were all correct PATHWAYS chosen based on the answer to ENTRY question #11 (type of abuse and neglect)? 99% 98% 99% 99% 98%
    Was the call correctly classified as a CA/N Report? 98% 99% 99% 99% 99%
    Was the correct Response Priority chosen (3,24, or 72 hour)? 99% 99% 98% 98% 99%
    Was the correct Track assignment chosen (investigation or Assessment)? 97% 98% 97% 98% 98%
    Was the county of assignment correct? 100% 100% 100% 100% 100%
    Total number of records reviewed each qtr/year 1244 1477 1188 1335 5244

    Child Abuse/Neglect Reports

    During CY08, there were 54,932 Child Abuse/Neglect incident reports. This is a 3.6 percent increase of 1,948 reports from CY07. More telling is the 75,781 children reported during CY 08, an increase of 12,498 children (19.7 percent) from CY 07. This indicates that reports called in during FY08 involved 53.08 children per thousand statewide.

    In CY08, 6,732 children were found to be victims of child abuse/neglect by a preponderance of the evidence. Neglect was determined for 45.9 percent of these children. Physical abuse was determined in 25.0 percent. Sexual maltreatment was determined in 22.9 percent. Emotional abuse was determined in 4.9 percent. These numbers reflect only a slight change from CY07, the most significant being for neglect victims, which decreased by 1.2 percent.

    In CY08, 62.7 percent of children with substantiated CA/N reports were abused and or neglected by one or both (biological/adoptive) parents. Stepparents, grandparents, siblings, or other relatives were responsible for 28.0 percent of these cases, which accounts for an 11 percent increase to CY07. Approximately .04 percent, the perpetrators were of an unknown relationship to the child, which indicates a 3.6 percent decrease in establishing a finding of abuse/neglect without being able to determine the relationship of the victim child to the perpetrator.

    The National Standard for CA/N recidivism during the first round of the Child and Family Services Reviews (CFSR) was 6.1 percent or less. Missouri’s performance at the time of the CSFR was 8.3 percent. The CD improved performance for this measure and successfully exited the Program Improvement Plan (PIP) in March 2008. For CY 2008, our internal measurement for this standard is 4.10 percent.

    The National Standard for children in foster care to remain free from being involved in an abuse or neglect incidences in 99.68% of all cases in a 12 month period. The CD exceeded this benchmark with 99.74% of all youth in care being free from involvement in CA/N incidences in foster care during CY 08.

    These two Standards are discussed in more depth in the Five Year Progress section.

    Child Abuse and Neglect Investigations/Family Assessments

    In CY08, 52 percent of the calls received at the child abuse/neglect hotline unit met statutory requirements for child abuse and neglect reports, and were assigned to an investigation or family assessment track for follow up.

    In CY08, approximately 42.8 percent of CA/N reports were completed as Investigations. Of those, approximately 8.2 percent were substantiated and about 28.7 percent were unsubstantiated. Preventive services were indicated in 5.9 percent of the unsubstantiated findings. While the rate of substantiated cases decreased by approximately .08 percent, there was a decrease of nearly 5.3 percent for unsubstantiated reports, and a nominal change of .02 percent decrease of preventive services indicated from CY07. This difference is believed to be attributed to changes stemming from the higher evidentiary standard of proof required in order to substantiate reports. The CD, in collaboration with the DSS, Division of Legal Services, the Children’s Division provided state-wide training for management and staff during CY07-CY09 on the Preponderance of Evidence Standard of Proof. In addition, a second level administrative review process was reinitiated which allowed a second level of review by management staff of substantiated cases.

    In CY08, 51.7 percent of CA/N reports were conducted as Family Assessments. The CD is monitoring possible trend changes between investigations and family assessments, as there appears to be a slow and steady decline in the variance between the two tracks at report conclusion.

    Field staff are reporting improved ability to identify reports and referrals as duplicates, which could potentially be impacting data submissions.

    Miscellaneous determinations account for 5.6 percent of the CA/N reports, and include Unable to Locate; Inappropriate Report; Located out of State; and Home Schooling. This is a nominal change from CY06.

    The CD continues to focus attention and resources on its core functions. Investigations and assessments for CA/N remain a top priority for the Division. Technical assistance was provided to local offices by central office staff to assist and support investigation and family assessment duties during periods of staff and/or supervisor shortages, and to ensure timely completion of reports. Significant improvements were made in timely completion of CA/N reports during CY07-CY08.

    During CY07, the Missouri Supreme Court handed down a decision (Jamison Decision, March 2007) addressing the constitutionality of the Division’s child abuse and neglect determinations, the Child Abuse and Neglect Review Board (CANRB) hearing process, and the issue of whether proper due process is afforded to individuals alleged to have committed child abuse or neglect. Policy, practice and form changes implemented during CY06 continued during CY08 requiring individuals who were determined by the agency to be perpetrators of child abuse and neglect (based on a preponderance of evidence standard of proof) have their names withheld from the central registry until either their appeal request period had expired or the agency’s finding was upheld through the appeal process. The letter mailed after the finding has been made informs the perpetrator of their right to request an appeal and explains the process and timeframe for doing so. Additionally, the information system was modified to accommodate this requirement by reflecting the appeal time and request for appeal status before a final conclusion is entered.

    Non-CA/N Referrals (Preventive Services)

    While 54 percent of the child abuse/neglect hotline calls received met statutory requirements for child abuse and neglect reports, another 33 percent calls did not, but were accepted as non-CA/N referrals (34,635). These calls of concern included Mandated Reporter Referrals, Non-Caretaker Referrals, Newborn Crisis Assessment Referrals, Preventive Services Referrals and Non-CA/N Fatalities. Approximately one-fourth of these referrals were forwarded for Preventive Services, consistent with the previous two years.

    The CD continues to work on collaboration issues with other community responders related to non-caretaker referrals. Presently, no policy or practice changes have been implemented by the CD, however, it is anticipated the juvenile offices and law enforcement agencies will be assuming primary accountability for investigating reports screened out by the CD due to lack of care, custody, and control by the alleged perpetrator. However, the CD will continue to provide preventive services and supports to families with safety planning related to the offending behaviors in non-caretaker referrals when they involve children.

    Newborn Crisis Assessment and Services

    Pursuant to Chapter 191 RSMo, the division must respond to calls to the child abuse/neglect hotline in which a home assessment is requested by a physician or other medical personnel when they have serious reservations about releasing an infant from the hospital and may be sent home to a potentially dangerous situation. There may also be other non-drug related situations in which a physician/health care provider is concerned about releasing a newborn infant from the hospital. Non-drug involved referrals are accepted until the child is one year of age.

    The process of how the family is contacted, assessed, and referred for services to the local DHSS/Special Health Care Needs (SHCN) Regional Office remains unchanged. During CY08 2,805 calls were screened at the CA/N Hotline as Newborn Crisis Assessments. In CY07, 2,774 calls were screened as Newborn Crisis Assessments compared to 2,704 in CY06 and 2,539 in CY05. These numbers vary slightly from the previous APSR updates due the FACES conversion and a more accurate screening process and classification of these reports.

    Background Screening and Investigation Unit

    The Background Screening and Investigation Unit (BSIU) continue to conduct background checks for Missouri employers for their current or prospective employees/volunteers who have responsibility for child care/supervision. These checks assist the employers in assessing if the employee is an appropriate child caretaker. The checks may also be requested by parents/legal guardians for prospective child care providers for their children. During 2008, BSIU processed 117,970 screenings, a nominal increase from 113,473 in 2007.

    An on-line background screening system was implemented in August 2008. This new system allows background screenings requestors to input identifying information into an electronic application form. The on-line screening procedure has significantly improved response time, and in many cases the screening results are received by the next working day.

    Child Advocacy Center (CAC)

    Child Assessment Centers (CACs) are a safe and neutral place where children can go to ensure they receive specialized forensic, medical and therapeutic services necessary to treat the effects of physical, emotional and psychological trauma caused by abuse. CACs provide a safe place where law enforcement, prosecutors and Children’s Division’s investigators can work together to explore abuse allegations in a manner sensitive to the needs of young victims and their families. CACs in Missouri are regionally located and provide services to all of Missouri’s counties. Missouri has fifteen regional advocacy centers with the main offices located in: St. Louis (two locations), Kansas City, St. Joseph, Springfield, Joplin, Sedalia, Trenton, Sullivan and Desoto, Wentzville, Cape Girardeau, Doniphan, Columbia, Parkville, Osage Beach, and Branson West. Satellite offices are also located in: Nevada, Pierce City, Poplar Bluff, Ellington, St. Robert, Farmington, and Hannibal. In total, CAC services are provided in 24 locations around the State.

    All Centers in Missouri are accredited by the National Children’s Alliance. Centers go through an extensive accreditation process which requires that Centers meet eleven areas of criteria for providing services. All Centers are reaccredited every five years. In calendar year 2008, Child Advocacy Centers provided full forensic services to 5,859 children. Child Advocacy Centers provide a child friendly facility bringing together highly trained forensic interviewers and child advocates with multidisciplinary team investigators. This limits trauma to the child and facilitates a more effective investigation. Child Advocacy Centers also provide access to full forensic medical examinations by specially trained medical professionals.

    Sexual Assault Forensic Examination (SAFE)-Child Abuse Resource and Education (CARE) Network

    In SFY 08, SAFE-CARE exams were conducted by 91 participating providers and a total of 2,713 exams were completed. SAFE-CARE exams are at times conducted at the physician’s medical office; however, they are also completed at Child Advocacy Centers (CAC). The SAFE-CARE exam process allows for a one-time interview of the victim, with the opportunity for the physical examination to occur in the same location, preventing unnecessary stress and trauma to the child victim and their family. CACs often facilitate scheduling the exams and interviews to further assist in the investigation process.

    In SFY 08, the SAFE-CARE Network received $291,000 in state funding to enhance the statewide medical response to child maltreatment. Through a contract with Missouri KidsFirst, this funding was utilized in the development of three Resource Centers, a part-time Medical Director, and a tiered system of care. The Resource Centers are located within the state’s three largest children’s hospitals. Resource Centers provide training to SAFE-CARE medical providers, multidisciplinary team members, and primary care medical providers. Mentoring and preceptorship programs will be available for providers who are new to the field of child maltreatment. Online training modules are also being developed.

    Missouri KidsFirst is the state office for Missouri’s CACs. Collaboration between Missouri KidsFirst, individual CACs, Missouri Department of Health and Senior Services, and Missouri Children’s Division has been essential to the restructuring of the SAFE-CARE Network and the development of the Resource Centers.

    On August 28, 2007 state law RSMo 191.225 was revised, making the Missouri Department of Health and Senior Services (DHSS) the first payer for adult and child sexual assault forensic exams. SAFE-CARE Network staff worked with many public and private sector partners to implement a new payment system.

  2. Permanency

    Alternative Care Services

    Alternative Care is temporary care by the Children’s Division for a child who has been removed from his or her home due to dependency, abuse or neglect. The goal for most children in alternative care is to return to their parent(s) when the circumstances which led to out-of-home placement have been resolved. However, sometimes children are not able to return home and need a permanent family. Out-of-home placements are selected to provide secure, nurturing and homelike settings for children.

    Permanency planning and concurrent planning begin within the first 24 hours after a child is removed. Children’s Service Workers schedule a meeting with the family within 24 hours of removal to discuss the plan to get the child reunified if that is the case plan. Family Support Team Meetings are held within 72 hours of placement and every 30 days thereafter until court adjudication. After court adjudication, meetings are held as needed but at least every 6 months to discuss permanency and review progress. During the 72 hour meeting, the family support team develops the preliminary written service agreement which establishes the plan for the first 30 day treatment period. The initial 30 days is critical to timely reunification thus efforts have been made to ensure that staff are meeting with their families to provide the needed support and resources. The child assessment and service plan must be developed within 30 days and updated every 6 months or more frequently as needed.

    As of March of 2009, there were 9,239 children in the legal custody of the Division. The January 2009 count of 9,092 showed the fewest number of children in foster care since January of 1995. The high water mark for this population was 12,521, reached in May 2002. Reasons for the significant decrease include: increase in preventative services, Adoption and Safe Families Act, and an increase in the number of sites who offer Intensive Family Reunification Services and contracted foster care case management. The Children’s Division is also encouraging the use of kinship and relative placements because research shows that these placements are more likely to remain stable for a long period of time and result in fewer moves for the child. Out-of-home resource placements include emergency shelter care, family foster homes, kinships homes, relative homes, behavioral homes, career homes, medical homes, group homes, and residential treatment centers. All out-of-home resource providers are required to be licensed, contracted, pass a child abuse/neglect background screening and a criminal background check. The electronic fingerprint live scan systems are designed for ease of use and for capturing high quality fingerprint images, helping to ensure superior acceptance rates and accurate criminal history information. The prints are submitted for processing to State and Federal Automated Fingerprint Identification Systems. Employees of group homes and residential treatment centers are also required to submit to the background screenings and checks.

    In July of 2008, resource staff and their supervisors were given the ability to access to the online Family Care Safety Registry to expedite the background screening process and to make the licensing process more timely and efficient.

    Partnering with both formal and informal community organizations to support families involved in child welfare is necessary to build stronger families and stronger neighborhoods. The CD believes child welfare services can best be provided through public/private partnerships, including:

    • St. Louis City based Family to Family Initiative provides the CD with an opportunity to develop culturally sensitive family foster homes which are located primarily in the communities in which the children live.
    • The Fostering Court Improvement program which is available in many judicial circuits across the state. This group includes the judge, juvenile office, CD, Guardian ad Litem, CASA, and any other necessary members of the community. The team meets monthly to discuss issues related to alternative care including how to provide better services for our children and families.
    • An extensive array of purchased services from local public and private contractors.
    • A comprehensive children’s mental hearth services system to meet mental health needs of children and divert children from going into foster care based solely on the need to access clinically indicated mental health services.
    • Funding streams such as psychiatric diversion to reduce barriers to obtaining needed services and preventing unnecessary psychiatric hospital placements.
    • Community-Based Child Abuse Prevention (CBCAP) services.
    • Foster Care Case Management Contract to serve children with multiple placement disruptions and requiring more restrictive levels of care.
    • Kinship Care to allow children to remain living within their extended family structure.
    • Transitional Living Program to offer different living situations for older youth which allows for autonomy while still receiving the needed support, services and supervision.

    Foster Care Strategies

    A redesign of the Behavioral and Career Foster Care programs has been under discussion by a subcommittee of the Foster Care Workgroup. This subcommittee has developed a proposal and recommendations to enhance current policy and provide consistency within the programs statewide. Some of the discussion has included combining the Behavioral and Career programs into one single program using different levels to define the needs of the child instead of labeling as Behavioral or Career. In addition, the Children’s Division is reviewing an assessment tool to define the needs of the child. Research has shown children in these types of placements do not have better outcomes and may, in fact, have more placement disruptions than children in traditional foster homes. The proposal addresses ways to enhance the skills of the current placement providers to meet the needs of children requiring specialized care rather than moving them to a different placement. Further, the workgroup has discussed the idea of staff going through specialized training so that they are able to provide additional support to placement providers. Portions of the proposal may be piloted in FY 09.

    In addition, recent legislation was passed that requires the Children’s Division to consider placing children in alternative care with grandparents over any other relatives or foster parents. Research shows that children who are placed with relatives initially have fewer moves and better placement stability.

    A bill was passed regarding educational rights for children in foster care. In the past, it has been up to the school district to allow a child in foster care to remain in their school district even if they move out of the school district. There has been a recent push in legislation to allow children to remain in their school district to maintain educational stability for the child. School is where children spend most of their day. School stability is important to the success of children in care.

    Two circuits in the state have also developed parent education videos that educate parents about alternative care, and the court system. During the video, several members of the community talk about what happens while a child is in alternative care and strategies to reunify timely. This tool has allowed parents to be more educated about the alternative care system and the court system.

    Throughout the process of accreditation, all the circuits in the state have been participating in case reviews which evaluate practice and services provided to families. After the case review, the information is used to develop strategies to improve practice.

    There has also been a recommendation to increase clothing allowance rates for all children in alternative care. If approved, this will go into effect July 1, 2009. In addition, a recommendation has been made for foster parents to receive a diaper allowance for children up to the age of 3 years old. Currently, the diaper allowance is only allowed for children up to 2 years of age. If approved, this will also go into effect July 1, 2009.

    Alternative Care Maintenance Rates

    Maintenance rates were increased for all traditional, medical and behavioral placements. The increased amounts seen by all foster, relative and kinship providers went into effect in August 2008.

    • Age birth to 5: $271 to $282
    • Age 6 - 12: $322 to $335
    • Age 13+: $358 to $372
    • Behavioral /Medical: $708 to $732
    • Career: $47 a day to $48 a day

    Kinship Care

    The Kinship Care program continues to be a successful component of the CD’s practice. The process of allowing 90 days to complete licensure is facilitating approximately 30 percent of children in CD custody to be placed with family and kin. The CD continues to make it a priority to locate these placements for children entering out-of-home care. A subcommittee of the Placement Stability work group developed recommendations for enhancing Kinship placements. The process is assisting in assuring that relative and kinship providers are able to meet the needs of the children and reduce the financial and emotional stress of the addition to the household. In SFY 08, 24.32% of all children in the care and custody of CD were placed in relative care.

    Specialized Care Management Contract

    The "Specialized Care Management" contract awarded to Missouri Alliance for Children and Families (MACF) in April 2006 has been renewed for another year. The contract is capped to serve a maximum of 350 youth in the Central and Eastern regions but through a cooperative agreement which was completed in December 2007, an additional 20 youth will be served in Jackson County and an additional 30 youth will be served in the Southwest Region. This agreement is specific to serve those youth currently in a residential placement identified as level IV or above level IV residential placements. This contract and agreement will provide intensive wraparound services and supports by ensuring a maximum case management ratio of 1 to 10, although some caseloads are below this limit.

    Negotiations were held with MACF to change some of the outcomes for the renewal of the Specialized Care Management contract. There are now 10 specific outcomes established for this contract dealing with Safety, Permanency and Stability and Child Well-Being.

    • 99.43% or more of all children enrolled with the contractor during the reporting period shall not be the subject of reports of child abuse or neglect where there is finding of a preponderance of evidence.
    • 95% or more of all children referred to the contractor during the reporting period shall not be on/or have been on runaway status.
    • 95% or more of children referred to the contractor during the reporting period shall not be or have been arrested or detained.
    • 85% of children dis-enrolled from the contractor must remain stable in their community placement for 90 days.
    • 75% or more of youth during the reporting period will not experience a same placement type or a more restrictive placement type move.
    • 50% or more of all children placed in residential care at the time of enrollment will be moved to a less restrictive setting within 120 days.
    • 95% or more of all children enrolled with the contractor during the reporting period must have received weekly face-to-face contact with contractor staff to ensure safety.
    • 90% or more of all children dis-enrolled or discharged must have had a physical examination within the past 12 months.
    • 90% or more of all children enrolled with the contractor during the reporting period must be enrolled in school or have successfully graduated.
    • 70% or more of all children enrolled with the contractor for six months or longer during the reporting period must have an improved CSPI score.

    All of these measures address the CD’s and MACF’s commitment to ensure youth are safe and stable and have the opportunity to be successful. Current performance indicates MACF met most outcome measures with these exceptions: less restrictive setting within 120 days if in a residential setting, weekly face-to-face meetings, and physical exams within the past 12 months of dis-enrollment.

    Foster Care Case Management Contract

    The movement from a fee for service model to a performance based contract for foster care case management services altered the payment structure considerably. Each contractor receives the base caseload which they were awarded. The base caseload and the percentage of children which are expected to move to permanency in 12 months are used to calculate the total number of additional referrals the consortium will receive throughout the contract year. The contractor is only paid for the base caseload. If they fail to meet the permanency expectation they will serve more children than what they are paid for. If they exceed the permanency expectation they will serve less than what they are paid for.

    The initial contracts were awarded on 6/1/05 to seven provider consortiums to serve the St. Louis, Kansas City, and Springfield regions. The St. Louis Region consists of St. Louis City, St. Louis County, Jefferson County and St. Charles County. The Kansas City region consists of Jackson County, Clay County, Andrew County and Buchanan County. The Springfield region consists of Greene County, Christian County, Taney County, Lawrence County, Barry County and Stone County.

    The current contracts were awarded to the initial seven consortiums effective 8/11/08. Three additional contracts were awarded 9/1/08 to serve 12 counties in the central and southwestern part of the state. These regions consist of Randolph, Howard, Boone, Callaway, Camden, Laclede, Pulaski, Phelps, Texas, Jasper, Newton and McDonald Counties.

    As of 2/28/09 the active caseload for private contractors consisted of 3,207 children. This compares to 9,546 children served statewide. Approximately 33.6% of the foster care population is served through contracted case management providers.

    In the Springfield and Kansas City areas, mirror units were established to replicate foster care case management contract requirements with in-house employees. The purpose of the mirror units was to compare outcome results to both the contractors and other in-house units to determine if the contractual requirements influenced children’s permanency.

    Other Permanent Living Arrangements

    The Family Support Team (FST) may determine during an administrative review or at the permanency hearing that there is compelling reason that the four preferred permanency options of reunification, adoption, guardianship or relative placement are not in the child’s best interests. The option of another permanent planned living arrangement (APPLA) may then be explored. APPLA is a specific permanent placement for the child, not just a foster care placement that can be indefinitely extended. The Children’s Division has identified all youth who have an APPLA goal and this information has been sent quarterly to the Circuits for review to ensure this goal is being used appropriately and that it meets the needs of the youth. The permanency goal should be discussed at every Permanency Planning Review. Children are placed in APPLA only in cases where the Family Support Team believes and has documented to the court that this placement will endure until the youth becomes independent. In addition, the placement provider is in agreement with the plan and is able and willing, with the assistance of the Division, to meet the safety, permanency, and well-being needs of the youth. The placement provider will make a formal Planned Permanency Agreement with the Division for this purpose.

    When a youth is in APPLA, all case management services are afforded the youth including working with the resource or birth family to assess risk, participating in the development of the permanency plan, identifying and providing needed services and meeting with the youth and family to ensure desired outcomes are attained. Services will continue until the youth is released from the jurisdiction of the court.

    The Foster Care Case Management (FCCM) contracted providers and the Children’s Division formed a workgroup to identify older youth in APPLA. Outcome measures were developed to recognize the positive work being accomplished with this population and identify strategies to address negative trends. Those measures to be tracked include:

    Outcome Measure 10/1/07 to 9/30/08 10/1/08 to 3/31/09
    Percent of youth who exited while in a positive living arrangement 70% 70%
    Percent of youth who exited in a positive educational component 68% 72%
    Percent of youth who exited with a positive employment outlook 64% 57%
    Percent of youth who exit with a positive community connection 91% 90%
    Percent of youth who exit with a positive Medical or Psychiatric outcome 83% 81%

    These outcomes will be tracked outside of the current contract period for one year to establish baselines for use in future contracts. Each FCCM contracted provider and CD mirror unit is responsible to report their outcomes to Central Office for compilation into a state wide report. The percentages in the table represent the APPLA outcomes measures for part of the first contract from 10/1/07-9/30/08 and half of the first year of the second contract.

    Foster and Adoptive Parents Recruitment

    Missouri utilizes a diligent recruitment model for potential foster and adoptive families that reflect ethnic and racial diversity of children in the state for whom foster and adoptive homes are needed. These diligent recruitment activities involve utilization of bus ads and grocery store checkout ads in locations consistent with the ethnic and racial make up of children in the foster care system for that area. Additionally, the Children’s Division coordinates with faith partners in communities throughout the state to showcase by presenting the photos and profiles of children currently waiting for adoption that are also representative of the population of children we are recruiting for in foster care. The Division is mindful when developing promotional materials for the foster adopt program focusing on children’s characteristics (race, ethnicity, age, etc.) which comprise our foster care and waiting adoption population.

    In an effort to address concerns for multiple moves for children, St. Louis City began offering new foster parents the unique opportunity to hold a dual emergency and traditional foster home contract in 2006. Children not having to move from an emergency to a traditional foster placement often resulted in less trauma to the children. This has assisted in the increased availability of emergency placement slots for after-hours placements. St. Louis City currently has 29 dually licensed homes. Twenty of these are on the emergency list and will take children after hours.

    As of June 30, 2008 there are approximately 575 homes approved by CD as adoptive homes that do not have adoptive children placed at this time.

    The CD has devised several strategies in an effort to continue meeting the national standard of 32 percent for all children who exited care to a finalized adoption within 24 months. In addition to the above efforts by state and local staff to recruit and retain resource families, local circuit meetings continue to be held with Juvenile courts to address procedures for filing of Termination of Parental Rights petitions. Access to legal representation has also been improved for CD staff through a joint memorandum and protocol with the Division of Legal Services. The number of finalized adoptions in FY 2007 was 1191 and the number of finalized adoptions in FY 2008 was 1117.

    As of 4/30/09 there were 1,689 children who were available for adoption and awaiting adoptive placement or finalization of adoption.

    The CD adoption recruitment plan has two components; a group of core activities for which Central Office and every county office will be responsible, and a group of optional activities from which offices may select. Through these activities, the CD desires to reach all potential families regardless of their cultural and socioeconomic status. The core activities of the recruitment plan include:

    • Distribution of informational packets
    • Completing family assessments timely, within 90 days
    • Regular use of the media for recruitment
    • Home for the Holidays collaboration with the Dave Thomas Foundation
    • Utilizing and maintaining CD Internet web page and working with two national sites where CD children are featured
    • Photo listing: http://dss.mo.gov/cd/adopt. This web site lists profiles and the pictures of approximately 200 of Missouri’s waiting children. This site is maintained by the Collaboration to AdoptUSKids http://www.adoptuskids.org site. The AdoptUSKids and National Adoption Exchange (www.adoptex.org) are national websites where Missouri’s waiting children are featured
    • Celebrating National Foster Care month (May) and National Adoption month (November) and include media campaigns and print materials for recruitment
    • Continued collaboration with community agencies and maintaining the CD recruitment efforts

    The optional activities for local offices include:

    • Northwest Adoption Event
    • Northeast Adoption Event
    • Linking Hearts Adoption Open House at Ft. Leonard Wood. Effort to profile children and meet families interested in fostering and adopting
    • Jackson Co. website allows waiting children to be featured as well as information to be shared with the public in electronic format regarding training classes and general information about CD programs. Sponsored by LINC of Jackson County
    • Heart Gallery
    • National Recruitment Saturday Celebration in St. Louis County
    • Faith based mini-conferences in St. Louis, Jackson County and Springfield
    • Jackson Co. and St. Louis have started a bus campaign to recruit foster and adoptive families
    • St. Louis also began a movie ad campaign that has been successful
    • Profiles of waiting children run in the Kansas City Star
    • Wait No More Adoption Events (Memo CD09-46)

    The following steps are completed for every foster/adoptive applicant and other adult household member (age 17 and older).

    1. The CA/N background screenings are conducted by the local CD.
    2. CA/N background screenings are requested from every state where the applicant and household member 17 years old and older has lived since 17 years of age.
    3. Each household member 17 years of age and older must register with the Family Care Safety Registry (FCSR). The registry is maintained by the Department of Health and Senior Services (DHSS) and searches the following systems:
      • CA/N records (findings of "Preponderance of Evidence" or "court adjudicated", or prior to August 28, 2004, "Probable Cause" findings)
      • Employee Disqualification List, maintained by the Department of Health and Senior Services (DHSS)
      • Child-care facility licensing records maintained by DHSS
      • Residential living facility and nursing home records, maintained by DHSS
      • Employee Disqualification Registry maintained by Department of Mental Health
      • Foster parent licensing records, maintained by the CD
      • Sex Offender Registry information maintained by Missouri State Highway Patrol (MSHP)

    State and national criminal record checks are completed for each household member age 17 or older, or any person under the age of 17 who has been certified as an adult. Fingerprints are required. The MSHP completes a state criminal record check and then electronically sends the fingerprint images to the FBI for a national search of criminal records.

    The criminal record check may reveal open and closed record information on individuals consisting of arrests, prosecutor and court actions, correctional supervision, and release. All felony and serious misdemeanor arrests including sexual offender registration information as defined under 589.400, RSMo. All alcohol and drug related traffic offenses are considered reportable criminal offenses.

    The CD Background Screening and Investigation Unit (BSIU) maintains a log of all criminal background checks completed on alternative care providers and applicants. Beginning in July 2005 the CD began using electronic fingerprinting. In the past 5 years BSIU has logged over 37,818 fingerprint results. Each year there is an average of 9,454 fingerprints logged.

    The division utilizes the electronic scan service for the collection of fingerprints. The service is called Missouri Applicant Processing Services, or MOAPS. After the FBI completes its search, results are forwarded to the MSHP, who forwards the results to BSIU.

    Case.net, the Missouri State Courts Automated Case Management System, is examined for any reference to Orders of Protection filed, either for a child or adult. There are limits to the use of Case.net.

    Adoption Services

    Missouri Law identifies the CD as one of the agencies which may place a child for adoption, and establishes time frames for the completion of court ordered/requested adoption assessments conducted once the child is placed in the prospective adoptive home. The court may direct any appropriate individual or agency, including the CD, to complete the assessment.

    When it is not possible or in the best interest of the child to return to their biological family, consideration is given to placing the child for adoption. Several factors influence this decision; the attachment of the child to his/her biological family, the parent’s ability and willingness to voluntarily relinquish the child for adoption, the juvenile court’s determination of whether or not parental rights will be terminated and the older child’s desire to be placed in an adoptive home.

    Persons who are interested in becoming adoptive parents currently apply at local CD offices. All applicants must complete the STARS/Spaulding training provided through the Division. CD workers and/or contracted providers, in coordination with the training complete the family assessment and screen suitable families. The home studies are initiated within 30 days of the receipt of the application and completed within four months for families to be considered for adoptive placements. Priority is given to those families interested in adopting a special needs child.

    The Division maintains an Internet web site Adoption Photo Listing that is located at http://dss.mo.gov/cd/adopt/. Children listed on the web site receive exposure on this site; they may also be featured on other sites such as the national AdoptUSKids site at www.adoptUSkids.org, the Adoption Exchange Website at www.adoptex.org. The Adoption Exchange also manages the Missouri Heart Gallery site located at http://www.moheartgallery.org. In addition to these sites, Jackson Co/Kansas City has a website for presentation of children in that region that may be accessed at www.kcchildren.org.

    The CD actively recruits foster/adoptive families and enlists the assistance of community partners as well as the faith communities through publicity efforts which utilize newsletters, printed promotional material, public service announcements and local projects.

    Subsidized Adoption Program

    Some children placed in out-of-home care will never be able to return to their birth home. Furthermore, many of these children suffer from handicapping conditions and others are older or are members of a sibling group. These factors make it challenging to find adoptive homes. Frequently, these children have special needs such as the need for medical care, counseling, therapy, or special educational services. The cost of caring for these children can be prohibitive for a potential adoptive family. Before the adoption subsidy program, the only alternative was to leave the children in foster care. Adoption subsidy gives the child the benefit of a permanent family while assisting the family who would otherwise be unable to adopt the child.

    In recent years, the vast majority of children placed for adoption by the CD have had special needs. The agency has devoted a large portion of its resources and placed a priority on finding homes for these children. As of June 30, 2008, 13,744 children were receiving adoption subsidies at an average monthly cost of $383.00 per child. Total expenditures for the adoption subsidy program have increased from $62,222,136.51 in FY 07 to $63,184,096.89 in FY 08.

    The CD released revised adoption and guardianship subsidy contracts on May 2, 2008. This contract is more streamlined and efficient for both families and staff. The purpose of this revision is to provide the best services to adoptive families, guardians and children in the most fiscally responsible way while requiring fewer steps for adoptive parents and guardians to maintain necessary services.

    Second Level Matching Team

    The Second Level Matching Team (SLM) consisting of regional adoption representatives continues to meet four times per year to facilitate matches for the hardest to place children who are awaiting permanency. This statewide team was developed to match waiting families with children available for adoption. The focus of this group has expanded to include the utilization of a specialized recruitment tool.

    The SLM Team Goals have also expanded to include serving as a forum to discuss and resolve adoption issues faced by field staff, assist in defining best adoption practice for CD, and completing quarterly adoption peer record reviews as part of the statewide Continuous Quality Improvement process. During 2008-2009, much of the time of the SLM team was spent reviewing information pertaining to the new policy guidelines that were developed in May of 2008. SLM team members were able to bring common questions and difficulties they were experiencing in their regions to the meetings and the team engaged in problem solving to come to common solutions for many of the difficulties pertaining to adoption subsidy across the state.

    Heart Gallery

    On May 1, 2009 the third Missouri Heart Gallery opened in Kansas City at the Crown Center. The gallery featured 188 photos including 248 children and is slated to travel across the state over the months of May through November. The gallery will travel to St. Peters, Hazelwood, Hannibal, St. Joseph, New Madrid, Cape Girardeau, Sedalia, Springfield, Joplin, Lake Osage Beach, St. Louis and Jefferson City. As a result of the gallery, over 120 children have found placement homes since 2006. As a result of the 2008 Heart Gallery 63 children have "Families in Progress". Additionally, calls of interest have increased from 547 in the first year to approximately 4836 in 2007. Calls have remained consistent over the last year.

    Inter-Country Adoption

    The Children’s Division (CD) is the licensing body for all child placing agencies in Missouri. Many of these agencies conduct international adoptions. The rules for licensing child placing agencies require that such agencies conduct a variety of adoption services. The adoption services provided to families adopting internationally include pre-placement planning, post-placement supervision, assessment of the child’s adjustment into the home, and support services. Adoption disruptions are also assessed by the child placing agency. The section of the child placing agency’s rules pertaining to international adoptions is in the process of being revised.

    Residential Treatment Services for Children

    The Residential Program Unit (RPU) has the responsibility for licensure/re-licensure, supervision and technical assistance for the Residential Child Care Agencies (RCCA) and Child Placing Agencies (CPA) in Missouri. Residential treatment provides specialized services for children needing more structure and intervention than a foster home can provide. Individual placements within the residential setting are monitored by the case manager and the Residential Care Screening Team (RCST) Coordinator assigned by area/region to assure children are placed in programs which can address their needs and move to a less restrictive setting as appropriate. In 2007, CD developed specialized positions, Older Youth Transition Specialists (OYTS) to work with youth, ages 16-21 years to assist in the preparation of transiting from dependency to self-sufficiency. Many of these youth are, or have been, in a residential treatment program.

    Seventy-five (75) licensed residential agencies, operating at one hundred and thirty-one (131) operating sites around the state of Missouri are available to provide services to youth in need of residential treatment services. These services include, at a minimum, individual, group and family counseling, medical and psychiatric services based on the treatment needs of the child. Some programs offer additional services in the form of recreational therapy, expressive therapies and educational services. Some agencies offer specialized services for various treatment issues such as autism, sexually inappropriate behavior and dual-diagnosis. Many have transitional living and life-skills training for older youth. Licensing rules require RCCA staff to have initial orientation and a minimum of forty (40) hours of on-going training per year specific to treatment issues of youth in residential programs. Currently twenty-six (26) RCCAs are accredited and three (3) are actively seeking accreditation.

    In recent years, there has been a decline in the number of children requiring residential treatment services. Throughout SFY 08, 3,165 children received residential treatment services compared to over 3,500 in SFY 07 and 3,800 in SFY 06. This decline is due to several factors including fewer children coming into care, placement in a kinship/relative home, or being protected in their own homes. When placement is necessary, more children are being diverted from residential treatment by being served in a therapeutic foster care environment. More effort has been placed on moving older youth out of residential treatment and into a family environment. During fiscal year 2008, 1,138 youth over the age of twelve (12) years were transitioned out of residential treatment into a family setting, including one hundred and ten (110) youth returned to their parent(s).

    RPU staff work with RCCAs to design and conduct biannual meetings to present speakers on topics of mutual interest. The meetings also allow agencies to network. RPU staff consults individually with agencies regarding issues of concern. RPU has worked with the National Resource Center for Youth Services (NRCYS) since 2003, to develop and promote the "Strengthening the Culture of Care" (COC) curriculum. COC is a strength-based training program that assists direct care staff in understanding, and working with, the unique needs of abused and neglected children. The goal is to increase child safety and nurturance while placed in residential treatment thus reducing physical altercations and/or the need for physical restraint. Most of the RCCAs utilize the curriculum in part or in full with their staff.

    In addition to the biennial meetings and the COC training, RPU has been working with the University of Missouri, Extension Service regarding another identified issue for children in residential treatment, that of risky sexual behavior. We are currently facilitating a "train-the-trainer" on "Making Proud Choices" (MPC), an eight (8) session group exercise designed to empower children to make better choices for themselves when confronted with peer pressure to engage in sexual behavior. MPC is an evidence based training endorsed by the Centers for Disease Control (CDC) as an effective program for reducing the risk of HIV/AIDS.

    In 2008, licensing rules for RCCAs were strengthened to include exclusionary criminal and child abuse/neglect backgrounds for employees and potential employees. Agencies that hold a contract with CD participated in a voluntary fingerprint survey of all of their employees, volunteers and interns.

    In 2007 and 2008, RPU staff presented information on emergency planning with special needs populations at the National Association of Regulatory Administrators (NARA) National Conference in Richmond, VA and Atlanta, GA, respectively, to encourage licensing professionals from other states to assist their agencies in emergency/disaster preparedness. RPU staff also presented on emergency planning at the 2008, Missouri Coalition of Children’s Agencies (MCCA) annual conference.

    RCST coordinators monitor placements of children within RCCAs to determine the effectiveness of the treatment program in preparing children to move to a less restrictive living situation. The Residential Care Screening Team (RCST) coordinators frequently conduct meetings to discuss the status of children in RCCAs which often include RPU staff and/or OYTS for consultation purposes. The OYTS assist in determining the youth’s need and/or ability to participate in a Transitional Living program and in obtaining access to an appropriate program.

    Child Placing Agencies

    In FY 2007 their were 70 licensed child placing agencies with an additional 23 operating sites for a total of 93 child placing operating sites. Of the 70 licensed agencies 23 agencies were accredited. The agencies placed 494 (domestic) and 572 (international) children for adoption. Several child placing agencies are involved in the performance based contract and the specialized contract which is discussed in other section of this report.

    Several child placing agencies have formed the Adoption and Foster Care Coalition (AFCC). Although not funded with IV-B monies, the Coalition is actively engaged in improving the lives of Missouri families and children. AFCC continues with the contract, Pregnancy Maintenance Network (PMN) with the Department of Heath and Senior Services. AFCC has provided services to over 3000 women with case management, housing, education, parenting and well-baby care and referral. AFCC continues to meet with legislators to advocate for adoption and foster care issues, resulting in the passage of a statute to make it easier for birth parents to achieve an adoption plan

  3. Partnerships / Collaborations

    Adoption and Foster Care Coalitions (AFCC)

    Several Child Placing Agencies throughout the state have formed a collation of agencies named the Adoption and Foster Care Coalition. (AFCC). Although not funded with the IV-B grant the Coalition is active in improving the lives of Missouri families and children. AFCC continues with the contract, Pregnancy Maintenance Network (PMN) with the Missouri Department of Heath and Senior Services. AFCC conducted its eighth (8th) annual legislative gathering. AFCC continues to meet with legislators advocating for adoption and foster care issues, as well as, providing comments to the Children’s Division (CD) on child welfare policy.

    Child Advocacy Centers (CAC)

    The Child Advocacy Centers are members of Missouri KidsFirst. Missouri KidsFirst is a not-for-profit organization that provides advocacy and support services to Missouri’s Child Advocacy Centers. Directors of each of Missouri’s Regional Child Advocacy Centers serve as the Program Board for the Missouri Network of Child Advocacy Centers under Missouri KidsFirst. The Board of Directors of Missouri KidsFirst is made up of a diverse group of professionals and leaders which include businessmen and community and civic leaders from across Missouri. The Board oversees and directs the management of Missouri KidsFirst which also includes the program Prevent Child Abuse Missouri, a Chapter of Prevent Child Abuse America, and administration of a contract creating Medical Resource Centers for training and support of Medical Professionals working with child abuse victims statewide. The Board will continue to work to address on-going issues relating to training, coordination and program development within the CAC Network.

    MoHealthNet Managed Care Committee

    The MO HealthNet Managed Care Consumer Advisory Committee (CAC) was formed to advise the Director of MO HealthNet (MHD) on issues relating to enrollee participation in the MO HealthNet Program. The CAC meets quarterly to discuss MHD Managed Care issues and for the Managed Care health plans to provide updates in their areas. The committee is comprised of several consumers who present their concerns from their areas of the state. Representatives from the various managed care health plans attend these meetings, as well as representatives from MO HealthNet Division, Family Support Division, Children’s Division, Legal Services of Eastern, Western and Southern Missouri, Medical Centers, Head Start, Missouri Primary Care Association or any other entity with a MHD interest. This committee opens the door for communication to occur so better service is provided to consumers in the state of Missouri.

    Task Force on Children’s Justice

    In 2008, the Task Force on Children’s Justice reviewed a case regarding the fatality of a foster child. This review is part of the Task Force’s function as a Citizen’s Review Panel. For this review, the Task Force requested that the Office of Child Advocate be involved as well. Interviews were conducted, various reports gathered, and state policies and training plans were discussed.

    Recommendations for the CD included:

    • Cases should be "flagged" that contain certain criteria that may make a case more difficult or have complexity due to the following factors:
      • Length of Time in Care
      • Level of Care required
      • Mental Health Diagnosis
      • Frequency of Moves
    • "Flagged" cases should only be assigned to qualified or seasoned workers. If assigned to a less qualified worker, additional supervisory time should be required to ensure the worker becomes knowledgeable of the case and the specific needs of the family.
    • Discussions need to be had regarding the possibility of removing the "two year" time limit for Judges hearing dependency cases
    • Reviewing CD policy that addresses continued efforts to limit the number of unnecessary moves for foster children
    • Ensure that Family Support Team meetings are being held when a placement change for a foster child is necessary
    • Ensure that when children in Alternative Care experience a traumatic event, that they receive appropriate wrap-around services following the trauma
    • Ensure that workers have additional training on appropriate boundaries with children and youth on their caseloads
    • Utilization of a trained mediator when a Family Support Team is not being effective in regards to progressing a child’s permanency plan
    • Provision of counseling services for a foster family and other inhabitants of the foster home following the event of a household member’s death
    • Provision of Reactive Attachment Disorder (RAD) in-service training for all foster parents
    • Ensure that all foster parents and placement providers are given any and all mental health information as well as medication information as mandated by law
    • Ensure that all foster parents and other placement providers are given a copy of the Foster Parents Bill of Rights
    • Review of the "Initial Placement Form" utilized by CD workers to determine the appropriateness of the form
    • Encouragement of foster parents to participate in the foster child’s therapeutic sessions as a participant, not only as a consultant, especially in situations where a child has been diagnosed with RAD
    • Expectations that the Family Support Team function in a manner to assure that the child’s needs, including permanency, are considered

    The CD will provide a formal response on the plan to implement those recommendations that are possible, tentatively in June 2009. Plans for public viewing are currently underway. The plan will be posted on the CJA internet website: http://dss.mo.gov/cd/cjtf/.

    During FFY08, CJA grant money was provided to the Child Advocacy Centers in Missouri, necessary to improve the processes by which Missouri could respond to cases of child abuse and neglect, particularly, child sexual abuse, or exploitation. Forensic examinations, victim interviews, referrals to treatment providers, gathering and retention of forensic evidence used for criminal prosecution of the offender, were made possible through funding provided by the CJA grant.

    CJA Support for the Child Advocacy Centers facilitated compliance with RSMo 210.001.1, which designates Child Advocacy Centers in Missouri.

    The Child Abuse and Neglect Review Board

    The Child Abuse/Neglect Review Board (CANRB) provides an independent administrative review of child abuse/neglect determinations when the alleged perpetrator disagrees with the "Preponderance of Evidence" finding of the Children’s Division. At the conclusion of each investigation, the Children’s Division investigator notifies the alleged perpetrator in writing of the finding, of the evidence supporting the finding, and of the alleged perpetrator’s right to seek administrative review within sixty days.

    The CANRB is a panel of nine private citizens from professions specified in Section 210.153 RSMo (http://www.moga.mo.gov/statutes/c200-299/2100000153.htm ). Each member is appointed by the Governor and confirmed by the Senate. The Children’s Division may establish more than one CANRB panel to assure for timely reviews. Currently, there are three boards that meet monthly in Jefferson City and a fourth regional board that meets monthly in St. Louis. A fifth board will be established to begin meeting monthly in Kansas City sometime in 2009.

    Each board conducts approximately eight administrative reviews each month. The board makes the decision by majority vote to either uphold or reverse the Division’s findings. During the CANRB review, the board hears testimony from the Children’s Division, the child’s representative (if he/she chooses to participate), and the alleged perpetrator. The alleged perpetrator may be represented by an attorney, but witnesses are not subpoenaed and cross examination is not permitted. If the CANRB upholds the Division’s decision, Section 210.152 RSMo allows the alleged perpetrator to seek judicial review in the circuit court of residence within sixty days of notification of the CANRB decision. At the judicial appeal, the alleged perpetrator may subpoena witnesses with the exception of the alleged victim and the reporter. The court may sustain or reverse the CANRB decision.

    During 2008, the four CANRB panels heard 304 cases and upheld 157 (52%) with the following outcomes:

    Outcome of Reviews CY 2008
    Board 1 Board 2 Board 3 Board 4 Total
    Upheld 28 65 37 27 157
    Reversed 52 24 44 27 147
    Total 80 89 81 54 304

    Board 4 was created in March 2008.

    Three review dates (Board 1, Board 3, and Board 4) were cancelled in December due to weather. (See Child Abuse and Neglect section for more discussion on practice changes and training on evidentiary support for CA/N reports which has decreased the number of reversals from 07 to 08).

    State Technical Assistance Team

    Our collaborating partners through the DSS, the State Technical Assistance Team (STAT), assists in child abuse/neglect, child sexual abuse, child exploitation and pornography, child fatality and other child-related investigations, at the request of the department, law enforcement, or other child protection agencies. STAT is responsible for managing the Missouri’s Child Fatality Review Program (CFRP), including training and support for the 115 county-based, multidisciplinary CFRP panels, as well as collecting data to identify trends, patterns and spikes in the number of child deaths, to facilitate the development and implementation of prevention strategies.

    STAT is supervised by the DSS Director and available 24-hours a day to respond to requests for assistance. STAT’s investigative responsibilities are considerably different than those of the CD. During 2008, STAT investigated 263 cases, up from 239 cases in 2007. Of those, almost 165 (63 percent) were sexual abuse or exploitation related. Prosecutors filed 147 felony charges during 2008.

    This multidisciplinary approach has proven to be a key link in the investigation and evaluation of child fatalities, which ultimately leads to meaningful prevention strategies.

    The State Child Fatality Review Panel (CFRP), consisting of members from various professional disciplines, meets quarterly to review topics and trends of concern. The Panel continues to recommend prevention efforts related to child deaths due to bed sharing, safe bedding and abusive head trauma. The CD and STAT continue to promote safe-sleep with the use of brochures and materials provided by the Missouri Children’s Trust Fund and the Department of Health and Senior Services. Additionally, Pursuant to 210.195, RSMo., the CFRP reviewed child deaths related to abusive head trauma (Shaken Baby Syndrome), as reported by local fatality panels, throughout the state. It has come to the state Panel’s attention that some physicians ("experts") are being paid to testify that such trauma is not inflicted. Researchers and a pediatrician from the University of Missouri-Columbia proposed a research study on abusive head trauma-related child fatalities. The state Panel endorses and supports the researchers' efforts in applying for a federal research grant to conduct the study, but to date, funding has not been granted. The CFRP annual fatality reports are available for review at the following website: http://dss.mo.gov/re/cfrar.htm.

    In addition, as a result of the reviews of individual child fatality cases, local CFRPs made other specific recommendations for prevention during 2008. Some of these included; educate students and teenagers on the dangers of shaking a baby, the abusive head trauma it can cause and what to do to prevent shaking a baby; educate on safety of electrical devices and electrical-related dangers in and around homes; provide news release/education about reporting child abuse and neglect, and the CA/N Hotline number, and the dangerous risks of bed sharing and unsafe bedding.

    Practice Alerts have been sent to all CD staff addressing safety issues involving infants and toddlers, and fire safety. The CA/N hotline number is available on the website accessible by the public, and red cards publishing the 1-800 hotline number are routinely disbursed during public training opportunities. Additionally, mandated reporters are routinely provided training by local offices as well as central office staff. This training includes information on how to report child abuse and neglect. Additional prevention efforts in the form of PowerPoint presentations and informational fact sheets can be reviewed at the following website: http://dss.mo.gov/stat/prev.htm.

    State Youth Advisory Board

    The State Youth Advisory Board (SYAB) reconvened at the end of FY08 and has met four times in FY09. The Chafee contract contains language requiring each region to nominate up to three youth for potential membership on the board. Transitional Living Program (TLP) contractors and Native American Indian Centers have also been invited to nominate youth. The SYAB will meet quarterly in FY10 as well and continue efforts to include Native American Indian Center youth participation in leadership activities.

    In FY09 the SYAB developed a youth profile for speaking engagements, leadership conferences and panels, planned a youth conference, reviewed and provided input for updating the SYAB strategic plan, the SYAB handbook, and "What’s It All About" a guidebook for youth in out-of-home care, provided input for the "Kids In Court Guide" for youth in care distributed by the court, prepared talking points/brochure for Child Advocacy Day and spoke to legislators regarding these, and provided input for Missouri’s treatment approach to foster care. In FY10 the SYAB will continue to provide input for programs and policies and advocate for youth in out-of-home care.

    The SYAB is planning a youth and adult leadership and empowerment conference for summer 2009. Youth are presenting workshops on coping skills, resources, permanency, leadership, milestones, and self-advocacy. The SYAB plans to have a conference every other year.

    Although the SYAB has grown and stabilized since reconvening, local regional boards continue to struggle with development and implementation. Technical assistance has been requested from the National Resource Center for Youth Development (NRCYD) and consultation will be provided at the youth conference for regional boards from a NRCYD staff member.

    The current SYAB members, as well as other older youth in care throughout the state, have been very active in participating in speaking engagements and workgroups to promote youth in foster care needs. SYAB members have presented at CD’s Older Youth Program Training statewide, and numerous other local presentations. Individual SYAB members have been active on various workgroups, including the Department of Mental Health Advisory Board, the Improving Educational Outcomes for Foster Children Advisory Team, and the Child and Family Service Review Advisory Committee, and the Office of State Court Administrators workgroup. Youth throughout the state have been participating at the national level in an internship in Washington D.C., through the Orphan Foundation of America (OFA) and with the FosterClub All-Stars. Youth in care and alumni youth have been selected as members of the Governor’s Task Force on Aging Out which convened in October 2008 and will submit final recommendations June 2009. The SYAB will continue to participate in speaking engagements and advisory boards/committees throughout the state in FY10.

    In FY10, the SYAB will continue to be the voice of youth in care and increase their visibility and participation in communities.

    Foster Care Case Management Partnerships

    Missouri’s performance based contracting is built on a public-private partnership with accredited agencies. Missouri believes child welfare is a complex arena and remains open to innovative approaches for case managing foster care children. Open communication with contracted providers is a critical component of Missouri’s privatization effort. This was evident throughout contract development and continues to date through meetings which occur on a regular basis at the local, regional, and state levels.

    In January, 2003, the contracted case management providers and state agency administrators were invited to participate in a discussion of a performance based case management contract. A meeting was held on 2/11/03. Plans to develop a performance based contract by 7/1/04 were diverted when Dominic James died at the hands of his foster father. Public and legislative outcry for child welfare reform ensued which included the development of contracts for comprehensive service delivery for children and their families by 7/1/05 in consultation with the community and providers of service. This led to regional meetings across Missouri in 2003 and statewide meetings of approximately 80 community stakeholders. The invitation list included current and potential contracted case management agencies and Intensive In-Home Services and Family Reunification Service contractors. In addition, each region sent invitations to community members such as child advocates, court personnel, legislators, and internal CD staff.

    At the statewide meetings information was provided from the three workgroups which were formed to develop portions of the Request for Proposal (RFP). The workgroups discussed the enrollment process, outcomes, and provider qualifications. Information was also distributed, in writing, to allow the 80 stakeholders statewide an opportunity to provide input on these portions of the RFP.

    Within the first six months of implementation of the performance based contracts Continuous Quality Improvement (CQI) Meetings were implemented at the local and regional levels. These meetings were designed to address implementation issues at the lowest level possible. Issues which could not be resolved at the local level were referred to the regional CQI. Issues which could not be resolved at the regional level were referred to the CEO meetings.

    As Missouri is now in the 4th year of a performance based case management contract time is set aside at the CQI meetings for quality assurance/best practice discussions. As such, invitations for the regional CQI meetings are sent to the public and private QA and QI specialists.

    Program Manager Meetings are held quarterly. These meetings now serve as the state level tier for the CQI process. This meeting is facilitated by a contractor. These meetings provide a forum to work on unresolved issues from the regional CQI meetings and an opportunity to share best practice. At the most recent meeting participants were put in small groups for discussion of strategies to develop permanent placements for older youth.

    CEO meetings are also held on a quarterly basis. Recent items of discussion have included expenditure reporting, background screenings, outcome measures, court collaboration, SACWIS compliance, and joint QA/QI initiatives.

    Joint Quality Assurance/Quality Improvement initiatives at the regional level include circuit CFSR Readiness Assessments, Program Improvement Plans to address deficiencies identified through the circuit self assessments, and Peer Record Reviews. Contracted staff, including their QA Specialists, are invited to attend the local CFSR/PIP meetings. The desired outcome is the development of joint QA/QI plans to address areas of concern and sharing of best practice.

    Joint QA initiatives at the state level include federal reviews such as worker visits with children, Child and Family Service Review and AFCARS/data integrity. Contracted QA staff will be invited to attend CD QA Unit meetings twice per year. The contracted QA specialists are now routinely engaged in data clean up efforts to achieve improved data integrity.

    On February 10th and 11th, 2009 Children’s Division and contracted QA staff attended a two day training sponsored by Kids Hope United. This provided an opportunity for private and public staff to collaborate, share ideas for quality assurance and best practice, and share tools.

    The PIP Advisory Committee, which was originally formed to monitor progress and develop strategies to improve areas of deficiency identified in the first CFSR, is comprised of CD staff and contracted agency representatives. This Committee continues to meet on a quarterly basis to prepare for the second CFSR.

    Within the first six months of implementation of the performance based contracts Continuous Quality Improvement (CQI) Meetings were implemented at the local and regional levels. These meetings were designed to address implementation issues at the lowest level possible. Issues which could not be resolved at the local level were referred to the regional CQI. Issues which could not be resolved at the regional level were referred to the CEO meetings. The local meetings continue to be held on a monthly basis. The regional meetings occur on a quarterly basis.

    As Missouri is now in the 4th year of a performance based case management contract time is set aside at the CQI meetings for quality assurance/best practice discussions. As such, invitations for the regional CQI meetings are sent to the public and private QA and QI specialists.

    Program Manager Meetings are also held quarterly. These meetings now serve as the state level tier for the CQI process. This meeting is facilitated by a contractor. These meetings provide a forum to work on unresolved issues from the regional CQI meetings and an opportunity to share best practice.

    CEO meetings continue to be held on a quarterly basis. Recent items of discussion have included expenditure reporting, background screenings, outcome measures, court collaboration, SACWIS compliance, and joint QA/QI initiatives.

    Joint Quality Assurance/Quality Improvement initiatives at the regional level include circuit CFSR Readiness Assessments, Program Improvement Plans to address deficiencies identified through the circuit self assessments, and Peer Record Reviews. Contracted staff, including their QA Specialists, are invited to attend the local CFSR/PIP meetings. The desired outcome is the development of joint QA/QI plans to address areas of concern and sharing of best practice.

    Joint QA initiatives at the state level include federal reviews such as worker visits with children, Child and Family Service Review and AFCARS/data integrity. Contracted QA staff will be invited to attend CD QA Unit meetings twice per year. The contracted QA specialists are now routinely engaged in data clean up efforts to achieve improved data integrity.

    On February 10th and 11th, 2009 Children’s Division and contracted QA staff attended a two day training sponsored by Kids Hope United. This provided an opportunity for private and public staff to collaborate, share ideas for quality assurance and best practice, and share tools.

    The PIP Advisory Committee, which was originally formed to monitor progress and develop strategies to improve areas of deficiency identified in the first CFSR, is comprised of CD staff and contracted agency representatives. This Committee continues to meet on a quarterly basis to prepare for the second CFSR.

    Education Advisory Team

    Improving Educational Opportunities and Outcomes for Children in Foster Care Advisory Team was formed in SFY 08. The Educational Advisory Team’s mission is to do all they can to assure that children in foster care are offered the same educational opportunities as those children not involved in the foster care system. The advisory team members represent a variety of disciplines including the educational system, foster parents, private and public child welfare, court-related child advocacy, juvenile justice and youth in out-of-home care. The Educational Advisory Team meets on a quarterly basis.

    The Educational Advisory Team recognized three initiatives to focus on how to improve the education opportunities and outcomes of foster youth. The Educational Advisory team divided up into three workgroups to meet the three initiatives. The three workgroups identified are: Raising Awareness, Engaging and Empowering Stakeholders and Developing Tools and Resources.

    Talking points are being composed to present to stakeholder groups throughout the state. The talking points will be based on the basic awareness of the issues regarding education and foster youth as well as what can be done to improve outcomes for foster youth. The group will shape the talking points around identifying the real issues.

    Missouri Prevention Partners

    The Missouri Prevention Partners is a collaborative group of public and private agencies that have implement interventions on a statewide basis that address the prevention of child abuse and neglect. This group of partners represents diverse approaches and perspectives in dealing with child maltreatment within a spectrum of prevention at the individual, family, community and societal levels. The Missouri Prevention Partners meet about every two months and are presently engaged in developing a strategic plan or framework to guide statewide and local efforts in providing evidence-based and best practice approaches to the primary prevention of child abuse and neglect.

    Goals for this group are:

    • Administration and Leadership - Create an Infrastructure to enhance and support child abuse prevention in Missouri.
    • Public Education and Outreach - Increase public awareness and involvement in child abuse prevention efforts in Missouri.
    • Prevention Programming - Promote the identification and use of evidence-based practices and promising approaches.
    • Resource Development - Develop flexible and sustainable funding mechanisms to support child abuse prevention efforts statewide.
    • Influencing Policy and Legislation - Impact policy and legislative issues through child abuse and neglect prevention focused advocacy.

    The agencies involved in the Missouri Prevention Partners include: Dept. of Social Services, Dept. of Health and Senior Services, Dept. of Mental Health, Dept. of Corrections, Dept. of Public Safety, Children’s Trust Fund, Kids Hope United, Practical Parenting Partnership, Head Start State Collaboration Project, ParentLink, Missouri Juvenile Justice Assoc, Citizens for Missouri’s Children, State Technical Assistance Team, and Missouri KidsFirst.

    Governors' Blue Ribbon Panel

    Former Governor Blunt appointed the Blue Ribbon Panel for Youth Aging-out of Foster Care in August of 2008. The seventeen member panel was comprised of Department Directors from the Departments of Social Services, Mental Health, Health and Senior Services, Higher Education, Elementary and Secondary Education, and Economic Development as well as representatives from private business/industry, current and former foster youth, private youth service providers, the juvenile court system, the Juvenile Justice Association, a Court Appointed Special Advocate, and a foster parent.

    The charge of the panel was to assess current and private resources within Missouri available to support youth in or exiting from foster care. The panel would recommend ways to improve and strengthen coordination, communication, and collaboration among youth serving agencies and private industry to maximize the efficiency and effective use of resources to support the youth and their healthy transition to successful adult roles and responsibilities. The goals outlined for the panel were better use of resources, better outcomes for youth through existing and emerging programs, and better futures for our youth and our economy.

    The first meeting of the Blue Ribbon Panel featured a presentation by five current and former foster youth. The youth discussed the challenges of older youth in the foster care system as well as barriers to successful transition from the system. This presentation made a significant impact on the Blue Ribbon Panel members who requested that these five youth be officially appointed to the panel.

    The panel met from October, 2008, until May, 2009. The panel focused on six primary topics: permanency and lifelong connections, physical and mental health, transitional supports, education, employment, and cross system collaboration. The final recommendations have been made and a report is being drafted. The final report is expected to be completed by the end of June, 2009. A formal presentation of the report will be scheduled for mid-July for the Governor’s office, panel members and Department Directors.

    CFSR Advisory Committee

    Formation of a committee to provide feedback for the Program Improvement Plan began in 2005 and has evolved into a Child and Family Services Review (CFSR) Advisory Committee governed by a Charter, see Attachment B. The CFSR Advisory Committee’s centralized focus is to build an advisory resource infrastructure and lead to a broader collaboration which will improve access and service availability, as well as reduce services and funding fragmentation. By using the same committee for several requirements, this has given the Children’s Division the capability to educate several disciplines and partners on the complex issues facing child welfare. Through this education, our partners are better equipped to understand the child welfare arena and why it takes more than one agency to make a difference in a life of a child.

    After providing feedback in this Title IVB Plan, the committee will be studying the services available around the state from the circuit statewide assessments. From this process, the committee will craft a set of recommendations for consideration by the Children’s Division.

    Comprehensive Children’s Mental Health Services System

    Section 630.097 RSMo further called for the formation of a "Comprehensive System Management Team" (CSMT) to establish the system detailed by the plan. The existing state System of Care Team was deemed appropriate to fulfill such a function and has thus been so designated and re-named. The CSMT has formalized its structure with the adoption of by-laws and continues to meet once per month.

    The statewide implementation of the Custody Diversion Protocol in partnership with the Department of Mental Health (DMH) mandates timely response to any parent voicing the intention to surrender custody so that his/her child may receive clinically indicated mental health services. The Custody Diversion Protocol was piloted in the fall of 2004 and fully implemented statewide in February 2005. As of March 31, 2009, 881 youth have been referred through the protocol; 843 of these youth or 96% have been diverted from state custody. Thirty-three percent of these youth remained in their homes and received community based services through DMH. The remaining 67 percent received some sort of out-of-home care either through DMH funding or through the CD’s Voluntary Placement Agreement (VPA). In any given month, approximately 65 youth are supported through a VPA.

    The Children’s Division has contracted with the University of Missouri, Columbia, to create a web-based training on Custody Diversion and Voluntary Placements. This training will be available to all CD, DMH and community stakeholders by the end of June 2009. Circuit-specific training has occurred to address identified concerns, and the continued approach and recommendation are to leverage resources and problem solving at the local level. Regional Mental Health Coordinators represent each geographic region of the state and meet on a quarterly basis with Department of Mental Health partners to help address local issues.

    Likewise, utilization of the Voluntary Placement Agreement continues to be utilized throughout the state as efforts to serve children in need of mental health services focus on a collaborative partnership with the juvenile court, the Department of Mental Health, and the CD.

    Community Based Child Abuse Prevention (CBCAP)

    In Fiscal Year 2007, Children’s Trust Fund awarded $300,000 to the four Missouri communities of Moberly, Poplar Bluff, Springfield and St. Joseph to continue the CBCAP grant project. These communities completed the fourth of a five-year grant process. Through incorporating a lead agency concept, the goals of the CBCAP communities are to:

    • provide a seamless coordination and delivery of prevention and family support services to families and their children;
    • reduce the duplication of existing services;
    • maximize the resources of public and private providers to better serve children and families; and
    • ultimately reduce the likelihood of child abuse and neglect from occurring.

    An important part of this grant is the collection of data on outcomes of these services. At the end of the fourth year, 250 high risk families consisting of 900 individuals were benefiting from this project. Many of these families were single parent families with very young children and few economic resources or community supports.

    The Missouri CBCAP model is recognized by the federal funding agency as attaining the highest level (Level 4) of program standards and performance indicated by evidenced based outcomes and successful replication of the program in other communities. Each CBCAP site continues to show statistically significant improvement in scores of standardized measures of family risk (Child Abuse Potential Inventory) and distress (Parent Stress Index) among parents participating. Families also report high levels of satisfaction with the services they receive.

    Reducing Repeat Maltreatment, "Small Test of Change"

    The Children’s Division is currently working with Casey Family Programs to better address families who come to the attention of child welfare services due to repeat maltreatment. The Children’s Division is participating in a Breakthrough Series Collaborative (BSC) to improve our practice with the assistance of Casey and an outside consultant.

    The Breakthrough Series Collaborative is a methodology adapted from the health care field; it originated with the Institute for Healthcare Improvement (IHI) and the Associates in Process Improvement (API) in 1995.

    In a year-long process sponsored by Casey Family Programs (to be completed September 2009), five Missouri teams focus on an "intractable" issue in child welfare practice, with Repeat Maltreatment being Missouri’s issue. The teams test multiple ideas, strategies, and tools on a very small scale-called "Small Tests of Change"-- in their pilot sites. They simultaneously share learning with other teams via the Internet, phone conferences, and three two-day meetings. The most successful field-tested and measurable strategies and tools are then rapidly introduced throughout the teams' jurisdictions or systems.

    The site groups have monthly conference calls, have come together for several face-to-face meetings, and utilize a "SharePoint" website where they are able to share information with each other electronically as to what they are working on to improve practice with repeat maltreatment families. This project was initially piloted in 2006 in Newton and McDonald counties as the "Building Healthy Families" (BHF) program. CD recognized that a small number of families who have a large number of repeat maltreatment events ultimately resulted in an accumulation of harm to the child, leading to out-of-home placements and costly services to reduce risk of abuse and neglect. Newton and McDonald counties developed a BHF brochure that was distributed to families and community partners. With some minor changes, this BHF brochure has recently been approved for use in the other four pilot sites as well. BHF pilot sites are working to obtain and maintain strong community support, particularly from the schools, who have been actively involved and making referrals to the program.

    Fathers for Life - Incarcerated Fathers Collaboration Project

    The Family Support Division was awarded implementation funding effective July 1, 2005 for this initiative. Twelve sites participated in the Fathers for Life Project. Two sites joined the project initially as Tier I sites. Tier I sites included the Missouri Valley Community Action Agency and the Delta Area Economic Opportunity Corporation. These sites are actively recruiting fathers and providing project interventions. In year two of the initiative, three additional sites joined the project as Tier II sites. These sites include the Community Action Partnership of Greater St. Joseph, East Missouri Action Agency and Grace Hill Settlement House. Tier III sites who began participating in the third year three are: Children’s Therapy Center Early Head Start, Sedalia; YMCA-Kansas City; Head Start, Independence School District; Head Start, Kansas City; Ozark Area Community Action Agency Head Start, Springfield; Douglass Community Services Head Start, Hannibal; Northeast Mo. Community Action Agency Head Start, Kirksville; and South Central Mo. Community Action Agency Head Start, Winona.

    Fathers who chose to participate in this project had the opportunity to benefit from a wide variety of project interventions such as 24/7 Dad; Focus on Fathering; Parents as Teachers (PAT) Group Classes; PAT Individual Parent Coaching; Parenting Apart Classes; Enhanced Employment Services; and, Mediation. This initiative allowed more fathers to get involved, and get educated. The initiative also encouraged community support and resource development for fathers.

    The funding for this grant ended in December of 2008, but planning efforts of the Executive Steering Committee and other key local and state partners at the conclusion of the Fathers for Life project resulted in consensus on a number of recommended next steps. Each of these suggested next steps is built on the over-arching goal of continued development and maturation of the Fathers for Life model while replicating it throughout Missouri and in the four-state region.

    • Build partnerships within the Head Start network in Region VII (Iowa, Nebraska, Kansas, and Missouri) to facilitate the replication of the Fathers for Life model in the other three states. It is projected that these efforts would further strengthen the durability of the model and the adaptability of the model to different state infrastructures and locales. At the same time, attempts to replicate the model are projected to further increase the impact of the investment already made in the Fathers for Life resources, thereby benefiting more fathers and their families.
    • Rebuild the state leadership in Missouri for long-term sustainability of the Fathers for Life model. This would involve a determination of the systemic ways that the Missouri Head Start Association and the Missouri Head Start-State Collaboration Office would assume leadership in maintaining the initiative within Head Start. It might also involve greater connectivity with the Early Childhood Comprehensive System initiative and the Missouri Re-Entry Process initiative in Missouri. The end result would be widespread usage of the Fathers for Life resources throughout the 22 Head Start grantees and their communities. It is recommended that outcomes of locally implemented interventions with fathers continue to be evaluated to determine their effectiveness.
    • Enhance the Fathers for Life resources by developing translations into Spanish and determining appropriate supplemental materials in Spanish. The quality of the Fathers for Life materials was perceived to be very high by all stakeholders who had the opportunity to evaluate them. An important next step would be increasing accessibility for persons who speak Spanish.
    • Since the Fathers for Life curricula were highly regarded, incorporation of these materials within a broader framework of fatherhood materials would be advantageous. A well-indexed compilation of fatherhood materials could result in easier accessibility, greater functionality, and more widespread usage of quality materials that may be under-utilized.
    • Adapt the Fathers for Life resource manuals for application in Correctional Centers. This recommended strategy would facilitate better preparation of fathers for reentry into society and fulfilling their parenting responsibilities.

    Building strong, effective partnerships requires a level of information-sharing and trust-building that takes time. Great strides were made at both the state level and the community level in stakeholders becoming oriented to the systems of others to accomplish the goals. The common vision of what is perceived to be good for families and for children continues to be a driving, unifying force of the stakeholders who were involved in the Fathers for Life project.

    Missouri KidsFirst

    During the past year, Missouri KidsFirst, voted to reorganize its operating structure and by laws and has established a new Board of Directors. The new board is made up of a diverse group of professionals from across the State and includes businessmen, community leaders, and professionals with financial and legal backgrounds. The new board is also diverse in its cultural configuration. The new board will oversee the management and development of Missouri KidsFirst as a not for profit organization. In addition, two new planning structures will be developed. A state level Advisory Council will be developed and will be made up of representatives from partnering agencies and state organizations. The Advisory Council will oversee the integration of the CAC Model into all the appropriate partnering agencies and organizations. The Advisory Council will also coordinate interagency training and planning activities. The second new planning structure will be the Program Counsel. The Program Counsel will consist of directors from the 15 regional CACs. They will continue to work together to address on-going issues relating to training, coordination and program development with in the CAC Network.

    Placement Stability Workgroup

    The Placement Stability Workgroup developed a subcommittee in 2007 to address Kinship Care. The subcommittee focused on efforts to locate and support Kinship providers. The committee submitted final recommendations for review in 2008. These recommendations include extending the licensure process period from 90 days to 120 days and waiving certain non-safety licensing standards in kinship homes. We surveyed field staff to determine if our agency should waive additional non-safety licensing standards for kinship homes. The consensus was that we would not change our current policy. We also determined that we would not extend the current licensure period of 90 days as the process can be completed successfully in 90 days.

    Projects and improvements to achieve progress with Kinship Care that did occur in 2008 included:

    • July 2008 - a new form, Caregiver Court Information form, was introduced to assist the resource provider with participating in the court process
    • July 2008 - opportunity for participating in additional parenting training was made more accessible with the introduction of a form to attend trainings provided out side of the CD
    • November 2008 - new forms were introduced to assist resource providers with the Fair Hearing Process
    • December 2008 - the transportation policy was revised to enhance the reimbursement of transportation costs
    • December 2008 - policy was revised to pay for fingerprinting costs for respite providers
    • December 2008 - additional resources were introduced to staff to assist with completing background checks on resource homes
    • December 2008 - revisions were made to the application for becoming a resource provider and the medical questionnaire form that provides for increased privacy
    • December 2008 - an additional requirement was introduced that resource providers must review, agree to, and sign that they will follow safe-sleep practices as outlined by the American Academy of Pediatrics
    • January 2009 - respite policy was revised to enhance the respite services available for resource parents including resources and support

    Supervision Advisory Committee

    This committee represents the "finest" supervisors from around Missouri. Supervisor participants are selected by the Regional Directors and are based on outstanding performance and strong leadership ability. The committee maintains its focus through a strategic plan developed with the assistance of the National Resource Center for Organizational Improvement (for more information see Supervisor Committee History).

    The committee is governed by a Charter, see Attachment C, and meets quarterly to discuss new or pending issues including policy, program and practice areas impacted by quality supervision. At the end of every meeting, a member of the Children’s Division’s Executive team attends and gets briefed on outstanding issues and proposed ideas to enhanced supervision across the state. The strategic plan and exec team’s response are shared with all supervisors through a Web link on the intranet. In addition, this committee plans a bi-annual conference which provides supervisors with enhanced learning opportunities.

    This committee also serves as a policy review team for the division.

    Indian Tribe Consultation

    Missouri does not have federally recognized Indian tribes in the state. However, there are three Indian centers--the Heart of America Indian Center, the American Indian Council and the Southwest Missouri Indian Center, which are active in the state. The Indian Centers participated with the CD in regards to training and consultation on the latest policy development.

    The Indian Centers were notified of SYAB meetings and were encouraged to participate with their youth. Although they have not participated at this time, CD will continue to seek their involvement in our activities. It is the intent of the CD to share with the Chafee contracted providers the names and contact information of the Indian Centers so as to have the contracted providers also engage in communication and possible resource sharing with the Indian Centers.

    All benefits and services under the programs are made available to Indian youth in the state on the same basis as other youth. All youth, ages 14 and older, regardless of descent, per policy, are to be referred to the Older Youth Transition Specialists for Chafee/ILP support and services.

    Fostering Court Improvement Project

    Missouri’s Fostering Court Improvement project is a collaborative effort to use agency and court data systems to improve case handling and outcomes through intensive data focused interaction and training for personnel in selected project judicial circuits. It combines training on the National Curriculum for Caseflow Management in Juvenile Dependency Cases Involving Foster Care with development, collection and analysis of Missouri specific court performance measures and integration and utilization of this information with the data available through an external website (www.fosteringcourtimprovement.org) and other sources within the CD. Quality Assurance (QA) staff from the Children’s Division assists circuit court staff identify trends and develop plans for improvement. The QA Specialists provide information to the local FCI teams.

    The AFCARS reporting system traditionally utilized a cross-sectional design which gathers child level point-in-time data rather than longitudinal child data from date of removal to date of discharge. This allows only point-in-time descriptions and retrospective reporting of outcomes rather than tracking children’s progress from point of removal to discharge out of foster care. FCI combines expertise developed at Emory University and University of Illinois at Urbana-Champaign to convert existing AFCARS data into a longitudinal data system that will support court performance reporting and data collection. The CD is now utilizing this software to stitch together Missouri’s six-month AFCARS submissions into longitudinal records. The longitudinal product created populates a new website that is to be posted online quarterly. The website ranks, by county, children’s division regions, and judicial circuits, a broad range of data items pertaining to removal, foster care population and discharges.

    Fostering Court Improvement was initially implemented in four judicial circuits: Circuit 13 (Boone and Callaway Counties); Circuit 22 (St. Louis City); Circuit 31 (Greene County); and Circuit 35 (Dunklin and Stoddard Counties). These circuits were among those with the highest populations of children in out-of-home placement. These sites received training in mid-October 2006. The project expanded to include the following three circuits which participated in the training provided in September, 2007: Circuit 23 (Jefferson County); Circuit 25 (Pulaski, Maries, Phelps, and Texas Counties); and Circuit 26 (Camden, Laclede, Miller, Moniteau, and Morgan Counties). In the fall of 2008, four more circuits were added: Circuit 2 (Adair, Knox and Lewis counties); Circuit 5 (Buchanan and Andrew counties); Circuit 40 (Newton and McDonald counties); and Circuit 45 (Lincoln and Pike counties). Each circuit volunteered to participate in the project.

    The 10-15 member teams which attended the training included the following: Judge; Court personnel such as juvenile officers and court administrators; Juvenile clerks; Attorneys who represents state (JO attorney & DLS attorney); Attorney who represents parents; GAL/CASA and CD; and community stakeholders such as contracted service providers. These teams continue to meet locally on a monthly basis. OSCA and the CD provide technical assistance to the project sites to assist them in identifying systemic areas for improvement and to develop and implement reform efforts. This support includes on-site visits and attendance at the monthly meetings.

    The circuits are responsible for reviewing the data collected by the Children’s Division and the Juvenile Court to determine areas for improvement. Several Circuits (13th, 22nd, 23rd, and31st) have conducted extensive case reviews on children in care in order to ascertain the needed changes. Because of these data reviews, circuits have developed parent education materials to help parents have a better understanding of the child welfare and court process when their children are placed in care. These range from pamphlets to videos to classes. Older youth are becoming more involved in their own decision-making by participating in Permanency Planning Reviews and attending court hearings.

    Court and agency practices have changed to better serve children. Guardians ad Litem are being appointed sooner. Older youth are educated about their rights and responsibilities. Cross training is occurring between court staff and agency staff. In addition, communities are being involved in ways not seen before.

    The future of the Fostering Court Improvement Project is bright. Circuits continue to request to participate. The goal of FCI is that every circuit will adopt these practices and it will no longer be a "project" but a common practice.

    Juvenile Court Improvement Project

    The purpose of the Juvenile Court Improvement Project (JCIP) is to develop and implement a plan for improvement which will result in timely, full and fair proceedings for children and their families and to provide for the safety, well-being and timely placement of abused and neglected children in permanent homes. The activities of the court improvement project are directed by the JCIP Steering Committee, which meets quarterly. Members of the Juvenile Court Improvement Project Steering Committee were appointed by order of the Supreme Court of Missouri in January 2004. Members serve on a 2-year term. In that same order, the Steering Committee was assigned to the Family Court Committee. The Office of the State Court Administrator staffs both committees.

    Appointed members include:

    • Honorable Cary Augustine, Associate Circuit Judge and Administrative Judge of the Family Court, 13th Judicial Circuit. Judge Augustine is also the liaison to the Family Court Committee.
    • Honorable Stanley Moore, Circuit Judge of the 26th Judicial Circuit
    • Honorable Robin Ransom Vannoy, Circuit Judge of the 22nd Judicial Circuit
    • Ms Lois McDonald, Missouri State Foster Care and Adoption Advisory Board
    • Ms. Beth Dessem, Executive Director, Missouri CASA
    • Ms. Bettie Haug, Director of Child Protection/Family Court, 23rd Judicial Circuit
    • Mr. Phil McIntosh, Guardian ad Litem, 2nd Judicial Circuit
    • Mr. Perry Epperly, Family Court Administrator and Chief Juvenile Officer, 31st Judicial Circuit
    • Ms. Susan Savage, Assistant Deputy Director, CD, Missouri DSS
    • Mr. Jeff Adams, Training Program Manager, CD, Missouri DSS
  4. Practice

    Foster Care Strategies

    See Annual Permanency Section, Foster Care Strategies

    Fatherhood Initiative

    The Children’s Division is making diligent efforts to improve outcomes for children by ensuring noncustodial parents are actively engaged in case planning. Currently the focus is on fathers, because in most instances, fathers are the noncustodial parents. A fatherhood workgroup has been established with CD staff and community partners. Recently a survey was distributed to field staff across the state to assess how "father friendly" CD was when dealing with fathers. The data was collected and analyzed, and discussed with the workgroup.

    The workgroup recently met and decided a statewide fatherhood committee was needed to fully address areas of need to improve child welfare practice and outcomes. In addition the workgroup felt a need for a governing charter to and strategic plan to keep the work of this group focused. Once additional government and community partners are identified and invited into the workgroup, development of the charter and strategic plan will begin.

    Interstate Compact on the Placement of Children

    The progress achieved in this fiscal year includes the continuing awareness and implementation of Public Law 109-239 (Safe and Timely Interstate Placements). The implementation of clearer policy has strengthened the worker’s ability to set deadlines and make all parties accountable to comply within the 60-day timeframe to meet the established goals. A training session was videoed, placed on the Children’s Division (CD) Intranet, and distributed to CD Circuit Managers and Juvenile Courts to offer continued education on the policy and procedures of ICPC. In conjunction with the Office of State Courts Administrator, Interstate Compact for the Placement of Children (ICPC) participated in the Court Improvement Program to improve procedures to resolve barriers of moving children into permanency.

    In SFY-08, Missouri ICPC served 3,018 children, which included 662 requests for services from other states for Missouri children, and 858 out-of-state requests for Missouri services on behalf of children from other states.

    Missouri’s border agreements with Illinois and Kansas remain in effect relative to parent and unlicensed placement resources in coordination with ICPC.

    Native American Collaboration

    The CD Central Office has undertaken a considerable effort in the past year to improve compliance with the ICWA. The division has utilized training/TA through the National Resource Center (NRC) to provide ICWA training to top level management from each of the regions. Additional training was provided to field staff across the state, completed late fall of 2008. An Indian Ancestry questionnaire was developed for use at the onset of any alternative care case. The questionnaire is to be completed by every family where a child is at risk of being removed from the home to document any or no Indian heritage. State ICWA policy was modified to clearly and concisely guide a worker through the ICWA process when an Indian child has been identified. An ICWA checklist was also developed to assist a worker with ICWA compliance. It is our intent to assist staff in identifying Native American children and families and in locating appropriate resources.

    CD Central Office staff attended the American Indian Symposium in November 2008. Staff were trained on Indian culture and effective tribal collaboration. Staff attended workshops that dealt exclusively with ICWA compliance issues.

    Please refer to last year’s APSR on the five major components of ICWA. There have been no major changes to how the state collaborates with the Indian Centers. During the past year, the Southwest Indian Center and The Heart of America Indian Center in Kansas City have been invited to participate in the quarterly CFSR Advisory Committee meeting. Neither agency attended nor did they respond to the invitation.

    Cooperation is maintained with the state or tribal court assuming or having jurisdiction over a Native American child when providing services. Missouri courts assume secondary responsibility when the tribal court does not take jurisdiction. In any juvenile court proceedings, the Native American custodian or tribe of the child has the right to intervene at any point. All parties to the proceeding have the right to examine all the reports, testimony, witnesses and exhibits upon which the court’s decision may be based.

    Discussions are ongoing regarding the recruitment of Native American youth for local or the state youth advisory board with the OYP contractors. Nonetheless, strengthening both local and SYAB recruitment continues to be an area of focus for the CD.

    All benefits, services and programs are made available to Indian youth in the state on the same basis as other youth.

    Indian Center representatives have also joined the CFSR Advisory Committee.

    Family and Children’s Electronic System (FACES)

    Missouri continues development of its single statewide system. Missouri’s final SACWIS component, Resource Management and Financial Management, is currently being tested and will be implemented by June 2010.

    As with any automation development effort, FACES struggles to keep up with the ongoing changes that need to occur in the production environment as well as the changes made to legacy system that need to be mirrored in the development environment.

    Continued data clean-up efforts have also been necessary to make the data converted from legacy systems conform to the new, more stringent processing rules in FACES. As data integrity issues are identified, FACES staff perform system testing to ensure that appropriate edits are in place in the new system, and if not, to add the necessary edits to prevent the anomalies in the future.

    The accompanying cultural change for staff has been a challenge as well, however FACES training sessions deliberately focused on the development of local FACES experts with the depth of knowledge necessary to provide the critical on-site support necessary to ease the transition.

    Annual visits by ACF analysts have provided valuable feedback to ensure that SACWIS requirements are met. An ACF visit is scheduled for June 22-24, 2009.

    Legacy Systems - Ongoing legacy systems changes has been a challenge for a variety of reasons, the primary one being that knowledgeable IT IDMS programmers are difficult to obtain and retain. Contracted programmers are currently providing this critical function.

    AFCARS Review - An AFCARS review was conducted in Missouri during March 2009. Several system changes and practice changes are required. The AFCARS Review Report is expected in July 2009, however Missouri is in the process of initiating and processing necessary system changes through a comprehensive AFCARS Improvement Plan.

    Child Care Efforts

    The CD is developing an interface with its Family and Children Electronic System (FACES) and the Family Assistance and Management Information System (FAMIS) which is supported by the Family Support Division (FSD). This system interface will provide child welfare workers with enhanced features in determining eligibility and authorizing child care for children receiving services through the child welfare system. This interface will streamline the child care system by allowing eligibility, authorizations, and child care providers to be paid through one system, thus improving the accountability of the child care program. The interface is expected to be completed by June 30, 2010.

    Additionally, the CD is developing a claims and restitution system to support the child care subsidy program. This system will streamline the identification, collection and management of child care provider claims. This system is expected to be completed by June 30, 2010.

    The CD continues to move forward with its efforts of developing an electronic time and attendance system for child care subsidy utilizing a biometrics application. The specific technology will use a finger imaging process to capture the identity of children accessing child care and any authorized adult assigned permission to remove children from child care settings. The technology will use a touch pad device, located at the child care facility, to check children in and out of care. A parent, or other authorized adult, will use their finger image to validate their identity and relationship to the child entering or leaving care ensuring child safety, and the child’s image will be used to capture the actual time child care is accessed. The touch pad device will capture a logarithm of the finger image to verify identity and eligibility information. This information will be transmitted back to the DSS child care subsidy system which will calculate the validated attendance and, ultimately, generate the appropriate payment to the child care provider.

    Older Youth Efforts

    Within the Older Youth Program (OYP) there are services and funding provided through the Chafee Foster Care Independence Program (CFCIP). The CFCIP is contracted out to private agencies to administer and deliver services and funding to older youth in foster care, youth adopted or that obtained legal guardianship after the age of sixteen as well as former foster youth. Implementation of contracts began January 1, 2008. The contract contains language about the Four Core Principles identified by the Muskie School of Public Services, University of Southern Maine and the National Resource Center for Youth Services for successful adolescent transition programs - positive youth development, collaboration, cultural competence and permanent connections. The expectations and requirements are that Chafee contracted providers will engage the youth in their case planning, design life skills instruction specific to the youth’s needs with youth input, and offer a variety of methods in which youth can gain competency in each life skill.

    The Older Youth Program (OYP) reflects the philosophy and the services offered to foster and former foster youth, ages 14 and older. The program addresses:

    • The philosophy of youth permanency and positive youth development
    • The responsibilities of case managers of older youth, Chafee Contractors, TLP Contractors, and Older Youth Transition Specialists
    • Procedures for using the Ansell-Casey Life Skills Assessment and the Adolescent FST Guide & Individualized Action Plan
    • Helpful resources to engage youth in permanency and education planning

    The Adolescent FST Guide and Individualized Action Plan assist workers and youth in the planned transition of a youth becoming an adult and leaving foster care. It details the goals of the youth and facilitates the involvement of identified adults in the youth’s life. Transition planning is completed ninety days prior to the youth leaving care and documented on the Adolescent FST Guide. In FY10, a memo regarding transition planning and Fostering Connections to Success and Increasing Adoptions Act as well as a PowerPoint presentation will be disseminated to staff and available on the intranet/internet.

    The Ansell-Casey Life Skills Assessment (ACLSA) is an evaluation of youth independent living skills. It consists of statements about life skills that the youth and his/her caregivers complete. The ACLSA was designed to be as free as possible from gender, ethnic, and cultural biases.

    A portfolio assessment is used for each youth 14-21 to give the youth the opportunity to take some control of the assessment and show what they have learned. It focuses on the growth and development of the youth’s potential.

    Performance assessment is used to show the direct observation of a youth’s performance and allows the youth to see their accomplishment with historical data on their overall life skill development. In FY09, a workgroup revised the performance assessment reporting tool, CD-95, Individual Life Skills Progress Report, to be more descriptive and in compliance with the National Youth in Transition Database (NYTD) domains. In FY10, this form will be available through the FACES system.

    In FY09, a pilot program was implemented in three of the seven regions of the state to examine the Transitional Living Program’s (TLP) utilization. At each Family Support Team Meeting, a TLP consideration form is completed by the case manager and signed by the youth indicating if a referral will be made and if not, reasons for this. The pilot will end in June and the workgroup will convene in July to review the data and discuss next steps for FY10.

    In FY10, sample file reviews will be conducted of youth receiving Older Youth Program Services. Reviewers will look at documentation and services being provided to youth 14-21 throughout the state in order to determine strengths and needs and improve upon these.

    In FY09, file reviews of the Older Youth Transition Specialists (OYTS) records on contracted providers and services began and will be completed in FY10. The reviewers are representatives from Budget and Finance, Contract Management and the Practice and Professional Development Unit. Reviewers are looking at documentation and services being provided to youth 14-21 throughout the state in order to determine strengths and needs and improve upon these.

    Chafee Foster Care Independence Program

    See Chafee Section

    Educational Training Vouchers

    See Chafee Section

    Healthy Care Services Plan for Children and Youth

    Missouri currently utilizes the EPSDT guidelines to ensure that children in care have developmental assessments as well as vision, dental and hearing services as outlined below: EPSDT screenings are known in Missouri as Healthy Children and Youth (HCY) screenings, or, simply, well-child checkups. Missouri Care follows the 2000 American Academy of Pediatrics schedule for preventive pediatric health care as a standard for screening frequency. The schedule is listed below:

    • Newborn 9-11 months
    • By one month: 12-14 months
    • 2-3 months: 15-17 months
    • 4-5 months: 18-23 months
    • 6-8 months: Each year, from ages 2-21

    Components of a full EPSDT screening include:

    • Health and developmental history (both physical and Behavioral Health)
    • Complete physical exam
    • Health education
    • Immunizations and lab tests, as indicated
    • Lead screening and testing, as indicated
    • Developmental screening
    • Fine motor/gross motor skills screening
    • Hearing, vision, and dental screening

    The Children’s Division is coordinating with the Department of Mental Health and the MO HealthNet Division to provide consistent comprehensive care to each child in a foster care placement. The work that is ongoing with both of these departments is designed to meet physical and mental health and dental care for children in the alternative care system. It is proposed that this coordination can be achieved by utilizing the electronic data, having a review done by medical staff as well as a protocol for use of this information for every child as a part of routine reviews and case planning. Additionally, the Division has begun pursuing coordination with DMH to identify multiple psychotropic drugs and or contraindicated medications automatically and alerts provided to staff to address. A review was done in 2008 to determine any contraindicated medications that were being prescribed to children and youth in alternative care and the Department of Mental Health sent notification to the providers where contraindications were discovered. Trends were reviewed by a workgroup of experts from DMH, MO HealthNet and Children’s Division, with the intent for these reviews to be on going.

    The Division is committed to designing a centralized, comprehensive medical record and is exploring the ability to create this record from existing systems with MO HealthNet and DMH through use of cyber access. A policy review is ongoing to determine the best practice to obtain the maximum benefit from the medical record including sharing the information at each case review and FST as well as reviewed for follow up with the supervisor during routine conferences. Additionally, all information will need to be updated in the FACES system to document the compliance with ongoing medical care and screening. Policy will be written to instruct staff on utilizing the medical record to benefit children.

    The Division currently utilizes MO HealthNet consultants when specific assessments or guidance on appropriate medical treatment is necessary. The Division welcomes the opportunity to work with a group of experts that can assist us with assuring best medical planning and follow through for children in A/C and is adding to what we are already working with in cooperation with DMH and MOHealthNet. The Division will be forming a workgroup with representatives of CD, DMH, and MO HealthNet to address the coordination and service provision.

  5. Prevention

    Family Support services are community-based services that promote the safety, permanency and well-being of children and families and are designed to maintain and strengthen families.

    Family-Centered Services

    Families entering the child welfare system due to reports of child abuse or neglect receive case management services referred to as Family-Centered Services (FCS). FCS may also be provided if the family requests preventive treatment services. Services are available to families, including expectant parents, who request services aimed at preventing child maltreatment or family dysfunction and promoting health and appropriate parenting skills. FCS seeks to empower the family and minimize its dependence upon the social service system. During SFY 08, there were 17,759 active FCS cases compared to 18,473 during SFY 07. There were 8,780 new cases opened and 9,024 cases closed during SFY08. These include service cases with intact families and families with child(ren) in out-of-home care. Approximately 35 percent of FCS families served were the result of substantiated child abuse/neglect reports and 18.4 percent were the result of Family Assessments. Family requests for preventive services were make up 33.86 percent of the group served.

    In SFY08 a workgroup was formed to utilize the Strengthening Families approach by embedding effective prevention strategies into existing systems. This workgroup is comprised of Children Service Workers, Children Service Supervisors, Children Service Trainers, Child Welfare Program Development Specialists, and Early Childhood Program Development Specialists. Strengthening Families focuses on family supports and resources that already exist in their homes and communities. Recommendations have been made on how to make use of the Strengthening Families five protective factors to help support families. The group will continue to meet and shape conversation around how to embed the Strengthening Families protective factors into our policy and practice.

    Intensive In-Home Services

    Intensive In-Home Services (IIS) is a short-term, intensive, home-based, crisis intervention program that offers families in crisis an alternative to out-of-home placement.

    CD staff provides intense, time-limited family preservation services to families for 25 percent of the cases and purchases services through contractors for 75 percent of the cases. Referrals are accepted 24 hours a day, seven days a week. An IIS Specialist carries two cases and assesses the family within 24 hours of referral. If the family is deemed appropriate, services begin immediately. Cases will not be opened for families when safety of the child cannot be assured. The IIS specialist is available to the family 24 hours a day, 7 days a week. The services are provided in the family’s home or natural environment that may include neighborhoods, school or work settings. The intervention is intensive with twenty hours a week or more devoted to each family. An average of eight to ten hours per week of face-to-face or telephone contact with families is expected. Services are time-limited lasting, four to six weeks.

    IIS services are available to all 45 circuits within the State of Missouri. In the last two years, there has been an increase in the number of IIS cases that CD handles in house and a decrease in IIS cases contracted out.

    An IIS referral is required in all cases when a Children’s Service Worker plans to recommend removal of a child. If a child is removed on an emergency basis, a supervisory conference is required within 72 hours and prior to the protective custody hearing to determine whether the family should be referred to IIS. In the last five years, CD has consistently used the IIS program. The IIS program has successfully diverted a significant number of children from entering alternative care. Specifically, in fiscal year 2008, 3,356 at-risk children were accepted into the IIS program. In each of the last five years, over 86% of families remained intact at the end of IIS intervention. The data supports the fact that specialists are assessing families and providing identified services families need to be successful, allowing them to remain intact.

    At the end of an intervention, satisfaction surveys are sent to families requesting feedback. Feedback is reviewed and practice and process changes are suggested to policymakers.

    In November of 2008, the IIS program was phased into Missouri’s SACWIS system - FACES (Family and Children’s Electronic System). Within this program, CD and contracted staff input contacts with families, family support team information, family assessment and resource information. This new information system is intended to streamline the IIS program statewide. In addition, the new system has promoted better communication between CD and contracted IIS providers as all parties have access to the same information regarding the IIS intervention. A new process was developed for referral entry and case opening which will enable the referral process to be consistent statewide.

    Building Healthy Families (BHF)

    See Repeat Maltreatment in Partnership/Collaboration Section

    Child Care

    The CD is the lead agency for the federal Child Care and Development Fund and administers the state child care subsidy program for low income and protective services families served through both the CD and the FSD. Currently, child care subsidies help support approximately 40,000 low income children with about 3,000 children identified as protective services.

    For Fiscal Year 2009, the Children’s Division was able to maintain the eligibility income limits at 127% of the Federal Poverty Level (FPL) and introduce a transitional benefit package for eligible households. The intent of the transitional benefit is to reduce the "cliff effect" where families find themselves having their out of pocket expenses go from approximately 10 percent of their income to being responsible for the entire child care cost. Child care providers received an increase to their child care reimbursement rates for FY 2009. Rate increases may apply to certain child care providers as a result of an overall rate restructuring. Rates were adjusted to better reflect the market in certain areas, as reported in a Market Rate Survey and established by DSS.

    The Contract and Compliance Team (CCRT) continues to generate cost savings in the child care subsidy program allowing the CD to reinvest into the program. To date, the CCRT unit has completed on-site monitoring of 2,893 of the approximately 5,000 child care providers receiving payment on a monthly basis. As a result 225 contracts or registration/payment agreements have been closed.

    Child care subsidy provides a necessary service to families within the child welfare system by providing concrete support during their time of need. The child care subsidy program assists in supporting the safety and well-being of children in low income families by providing parents with a choice other than unsafe environments for their children. Maximizing funding for child care subsidy ensures DSS is able to serve the greatest number of families in need. Timely and accurate payment ensures higher quality providers are willing to accept DSS subsidized children.

    School Based Service Worker Contracts

    During the 2008-2009 academic year, the CD contracted with 43 school districts throughout the state for 60 workers. The primary goals of the school based service worker agreement includes the prevention and early identification of children at risk of child abuse and neglect or other barriers which could limit full potential for success in the school setting, and early intervention and the provision of services to strengthen families.

    New contract requirements began with the 2007-08 school year, allowing for a more effective (outcomes based) reporting process. During the 2007-08 school year, there was an average per school per month of 13,245 of children enrolled in the contracted school districts. The school based service workers served approximately 6.9% of the children enrolled in school and approximately 4.7% of families.

    In addition to aggregate data, the workers also provide summary information on child abuse and neglect prevention activities performed for the children and families served. Services included referrals for child abuse/neglect, counseling, mental health, attendance or academic issues, classroom behavior, health/medical, domestic difficulties, drug and alcohol issues, personal needs (hygiene, clothing, etc), home visits, transportation, vocational, dental, and housing.

    Restrictions under Family Educational Rights and Privacy Act continue to prohibit identifying information on clients from being obtained through the schools; however, workers are monitored internally, on their performance in compliance with the state contract by the designated school supervisor.

    A committee of school based service workers was formed during the 2008-2009 school year to develop a quarterly newsletter. A newsletter will be developed for the upcoming school year to foster collaboration efforts between school districts and local CD offices, and will also include training information, hotline information, and other related subjects.

    Child Care and Development Fund

    The Missouri Child Care Resource and Referral Network (MOCCRRN) provided child care referral services for approximately 25,669 families during SFY 08. This includes referral calls and on-line searches. Of the 25,669 families who were provided referral services, 15,640 families accessed services on-line. The MOCCRRN also served as the primary training resource for child care providers. Trainings coordinated and provided statewide were developed by the Department of Health and Senior Services, Section for Child Care Regulation. The trainings are Basic Child Care Orientation Training (CCOT), Infant Toddler CCOT, and School Age CCOT. In FY 08, MOCCRRN offered 2,600 training clock hours for 14,950 participants in 1022 sessions.

    The OPEN (Opportunities in a Professional Education Network) initiative is the state’s early childhood professional development system and includes a Professional Achievement and Recognition System (PARS) and Trainer Registry. In SFY 2008, 1,107 participants were added to the PARS registry which totaled 6,880 participants. This registry tracks child care providers and their staff’s education and professional development. During the same timeframe, 224 trainers were added to the Trainer Registry which totaled 1,540. This registry tracks education and professional development of trainers who provide training to child care professionals. OPEN has been an intricate partner in the oversight of the Quality Rating System (QRS) pilot project. The QRS is an initiative which rates child care programs according to the quality of the program using a state approved rating tool. The data collected in the PARS registry along with the Trainer Registry is important to making QRS work statewide. OPEN provides statewide leadership on mentoring and articulation on early childhood career development.

    The Educare program provides training and technical assistance to subsidized child care programs. Educare is available in 63 of Missouri’s 115 counties providing opportunities for providers to enhance their care giving skills. In SFY 08, Educare impacted over 39,000 children in over 1400 programs. Educare also provides training on child care subsidy payment system to the providers, many of whom are referred by the Division of Finance and Administrative Services, Contract Compliance Review Team identified as needing technical assistance with subsidy requirements. In SFY 08, Subsidy Orientation Training was given to 154 participants.

    Early Childhood Development Education and Care Fund (ECDECF)

    The ECDECF was created by setting aside a portion of the entrance fees to riverboat casinos. This funding is set aside for four programs specified in Missouri statute and administered by DSS.

    1. Early Head Start (EHS)

      State funding currently provides one quarter of the total EHS slots available in the state. Federal funding provides the other three-quarters. Approximately one quarter of EHS families are teen parents. In SFY 08, ten Missouri EHS grantees served 1,062 children and continually provide 571 childcare slots for those eligible. MO EHS grantees partner with community child care providers to provide EHS services. In SFY 08, there were 2,229 non-EHS children impacted by the services of EHS professionals throughout the state. Head Start at the federal level was re-authorized in February 2008. There were many changes within the reauthorizations, which will have a major impact on Head Start programs. Program providers are anxiously awaiting clarifications and specific policies on these changes along with timeframes as to when these things must be completed. Some guidance has been released but clarifications are continuing to come from the Office of Head Start.

    2. Start-Up Expansion

      In SFY 08 there were 36 competitive bid grantees and 160 licensed slots were added by the new grantees. Of the 36 grantees, 25 were in the second or third year. Therefore, their licensed slots had already been added in previous years. There are eight Community Partnerships who also received this funding. They added 315 licensed slots within 76 child care facilities.

    3. Stay at Home Parent

      In SFY 08, 16 competitive bid contractors served 8,332 children in 6,823 families. Eight Community Partnerships received this non-competitive funding and served 221 families with children between ages 0-3. These contractors are required to screen the children for developmental delays and social emotional health by using the Ages and Stages Questionnaire and the Ages and Stages Questionnaire Social Emotional. The parental stress levels must be screened by using the Parental Stress Index. Contractors are also required to track how much time parents spent reading to the children and to provide developmentally appropriate books to the families. The competitive bid contracts were re-bid in 2008. In FY 2008, there were some changes to the requirements when the program was re-bid however, the goals remain the same.

    4. Accreditation Facilitation for Child Care Providers

      Accreditation funding provides a 20 percent increase in child care subsidy base rates to accredited providers as an incentive for child care providers to become accredited and to support the additional costs of being an accredited facility. Providers eligible for this base rate increase include providers accredited by NAEYC, NAFCC, COA, NECPA, CARF, and Missouri Accreditation. In order to maintain the integrity of the accreditation process, accrediting organizations must apply to DSS to be a recognized accrediting organization and submit extensive background information regarding the operation and quality of their program. Applications are reviewed by an impartial team of evaluators made up primarily from staff of universities and community colleges. Accreditation Facilitation services are available across the state through the Missouri Child Care Resource and Referral Agencies to assist child care providers that serve subsidized children to become accredited. These services vary across the state and may include but are not limited to on-site technical assistance, scholarships for staff, equipment and training. In SFY 2008 279 child care providers received these services. Eight Community Partnerships also receive this funding and in SFY 2008 they served 101 child care providers.

    Strengthening Families

    Across the country, early care and education programs, child welfare departments, and others are using the Strengthening Families approach to build five Protective Factors in families:

    • Parental resilience
    • Social connections
    • Knowledge of parenting and child development
    • Concrete support in times of need
    • Children’s social and emotional development

    Research shows that these factors reduce the incidents of child abuse and neglect by providing parents with what they need to parent effectively, even under stress. By building relationships with families, program staff can recognize signs of stress and build families' Protective Factors with timely, effective help.

    This breakthrough strategy for dealing with child neglect and abuse shows great promise because:

    • The Protective Factors have been demonstrated to work and are informed by extensive, rigorous research.
    • Activities that build the Protective Factors can be built into programs and systems that already exist in every state, such as early childhood education and child welfare, at little cost.
    • Strengthening Families has widespread support from social science researchers, state child welfare officials, early childhood practitioners, and policy experts. Currently, the Strengthening Families approach is being applied in 36 states.
    • Early childhood educators want to strengthen families: a National Association for the Education of Young Children survey shows that 97% want to do more to prevent maltreatment.

    Although Strengthening Families was developed in early care and education programs, partners in a large variety of settings working with many different populations are exploring ways to apply the approach.

    Strengthening Families Through Early Care and Education

    This initiative is supported by the Center for the Study of Social Policy and the National Alliance of Children’s Trust Funds through funding by the Doris Duke Foundation. Missouri has proceeded with the implementation of the Strengthening Families through Early Care and Education initiative. The goals are to incorporate five protective factors to the extent possible in CD’s early childhood and child welfare programs and to create better linkages with other child welfare systems through cross training and joint initiatives. The process began with selecting six pilot sites that will serve as exemplary sites with the hope that eventually they will mentor other sites in the Strengthening Families model.

    The pilot sites were chosen in FY 2007 along with a contractor to provide technical assistance in embedding the protective factors into their programs. The five protective factors: Parental Resilience, Social Connections, Knowledge of Parenting and Child Development, Concrete Support in Times of Need, and the Social and Emotional Competence of Children have been woven through or embedded within a variety of major initiatives and programs including; training for frontline child welfare staff, training for foster parents, the Parents as Teachers National curriculum, the Prevention module of basic child care orientation training for child care providers, the Children’s Trust Fund discretionary grant program, the statewide strategic plan developed under the national MCFH Early Childhood Comprehensive Systems (ECCS) Plan grant that guides the work of the Early Childhood Coordinating Board appointed by the Governor, the state Quality Rating System, and a variety of grants and initiatives of the various state agencies engaged in early childhood activities. This work will continue on an ongoing basis.

    Several individual city, county and community initiatives are also beginning to utilize the Strengthening Families model in their infrastructure to support parent involvement and to embed the protective factors in their programs and initiatives. In conjunction with the ECCS plan, the SFI steering committee will be developing outcome measures and strategies as part of the ECCS strategic plan. The CD is working to contract with someone as a project manager for this initiative to begin at the end of FY 08 and continue through FY 09. The project manager will work to move the initiative forward and to meet the goals of the original plan. Due to budget shortfalls the CD has not yet been able to contract with a project manager however the work continues.

    The CD is also working to embed the Protective Factors and SFI philosophy and framework in its child welfare policy, practice, and training.

    Intensive Family Reunification Services (IFRS)

    Intensive Family Reunification Services (IFRS) is a short-term, intensive, family-based program designed to reunify children who are in out-of-home care and who, without intensive intervention, are likely to remain in care longer than six months. Intensive Family Reunification Services are based on the belief that families can, through intensive intervention, improve their functioning, learn to meet the needs of their children, and gain support from within their community to enable families to be safely reunified. The goals of IFRS are to assist the family in removing barriers for the return of their child(ren), assist in the transition of returning the child(ren), and to develop a plan with the family which will maintain the child(ren) safely in the home for at least one year following the intervention.

    CD staff and contracted staff provide intense, time-limited family reunification services to families. Staff meets with families within 72 hours of the IFRS referral. An IFRS Specialist will carry no more than three families at any given time and a minimum of thirteen families annually. The intervention is intensive, averaging 13 hours per week, per family. The IFRS Specialist is available to the family 24 hours a day, 7 days a week. Services are time limited, usually 60 to 90 days.

    The North Carolina Family Assessment Scale for Reunification (NCFAS-R) was utilized for a pre and post functioning to measure changes in family functioning during an IFRS intervention. This tool is currently being used by staff and contractors statewide and will continue to be used as the assessment tool for IFRS.

    Families are eligible to receive IFRS if at least one child (0-17 years) is in the custody of the Children’s Division and placed in out-of-home care. Sites offering IFRS include:

    Site #741:   Lawrence, Barry, Stone, Newton, McDonald Counties

    Site #941:   Jackson County

    Site #942:   St. Louis City, St. Louis County, St. Charles and Jefferson Counties

    Site #943:   Boone, Callaway and Cole Counties

    Site #944:   Franklin, Gasconade and Osage Counties

    Site #945:   Cass and Johnson Counties

    Site #946:   Washington, Ste. Genevieve, St. Francois and Madison Counties

    Site #947:   Crawford, Dent, Iron, Reynolds and Wayne Counties

    Site #949:   Camden, Laclede, Miller, Moniteau and Morgan Counties

    Because of the growing need, eight new sites were added to expand the services to rural areas of the state which include:

    Site #841:   Andrew and Buchanan Counties

    Site #842:   Jackson County

    Site #843:   Maries, Pulaski, Phelps, and Texas Counties

    Site #844:   Jasper County

    Site #845:   Greene County

    Site #944:   Audrain, Montgomery, Warren, Pike, and Lincoln Counties

    Site #948:   Perry, Bollinger, Cape Girardeau, Scott, Mississippi, New Madrid, Pemiscot, Stoddard, and Dunklin Counties

    Site #950:   Christian and Taney Counties

    Of these sites, there are 8 IFRS specialists who work for the Children’s Division and 26 IFRS specialists who are contracted providers.

    The IFRS program continues to be used with high success rates. Children are reunifying with their families earlier with this intensive program.

    In November of 2008, the IFRS program was put into FACES (Family and Children’s Electronic System), which is Missouri’s SACWIS system. Within this program, CD staff and contracted staff input contacts with families, family support team information, family assessment, and court information. This new computer system is meant to streamline the IFRS program statewide. The new computer system will provide data on how many children were reunified through this program and their status at 3, 6, and 12 months following intervention. Then, program success can be determined.

    Crisis Nursery

    Crisis Nurseries provide temporary care for children whose parents/guardians are experiencing an unexpected and unstable/serious condition that requires immediate action resulting in short term care, and without this care the children are at risk for abuse and neglect or at risk of entering state custody. Crisis Nurseries serve children age birth through 12 years of age (and siblings of these children if necessary). Care for this age group is typically due to an immediate emergency where the parent has no other support systems to provide care and the child is too young to be left alone, such as parental incarceration, another sick child in the household, homelessness, domestic violence, parental illness, etc.

    Crisis Nursery services are provided free of charge to families voluntarily accessing services in response to such a family emergency. Crisis Nursery services are available twenty-four (24) hours a day, seven (7) days a week. A child will be accepted at a crisis nursery facility at any time, day or night, if space is available. Crisis Nursery contracts are awarded through a competitive bid process which was rebid in 2007. Currently there are twelve (12) crisis care nurseries across the state. In FY 2008 4,974 children were served in crisis care nurseries.

    Teen Crisis Care

    Teen Crisis Care Centers provide a safe haven for teenagers, ages 13 through 17 years, who are experiencing a crisis at home. Teens experiencing crisis, and lacking a safe haven, may also resort to participation in risky behaviors in order to survive. As a result these teens sometimes fall prey to predators, drug addiction, prostitution, and/or experience serious injury or, in the extreme, death.

    Older youth seek crisis care services as a result of problems that have been typically building over time, such as an altercation with a parent, being kicked out of their home, parental substance abuse or mental health issues, homelessness, or because of situations that place them at risk of emotional, physical, or sexual abuse. These situations typically take time to resolve or to make alternate more permanent arrangements. As a result, in addition to providing a safe place for a "cooling off period", teen crises typically require providers to assist in stabilizing the crisis within the family through mediation, referrals for appropriate intervention services, and/or the necessary referral to permanent support services within the community.

    Teen Crisis Care services are provided free of charge to families voluntarily accessing services in response to such a family crisis. Crisis care services are available twenty-four (24) hours a day, seven (7) days a week. A teen will be accepted at a crisis care facility at any time, day or night, if space is available. Crisis Care contracts are awarded through a competitive bid process which was rebid in 2007. Currently there are nine (9) teen crisis care centers across the state. In FY 2008 433 teens were served in the teen crisis care centers.

  6. Professionalism

    In addition to the Children’s Division directly providing training, other entities who will be used to provide short term training will include (but not be limited to) OSCA and CASA. Additional categories of trainees will include relative guardians; staff from state-licensed or state-approved child welfare agencies providing services to children receiving title IV-E assistance; child abuse and neglect court personnel; agency, child or parent attorneys; guardians ad litem; and court appointed special advocates per PL 110-351.

    Professional Development and Training SFY 09-10

    Children’s Division Professional Development and Training has continued to develop and deliver an initial core and ongoing in-service training program for all new Children’s Services workers and supervisors. The training is based in agency policy and best practice and is designed to provide a consistent core structure, but also provide ongoing in-service opportunities based on needs identified through individual, regional or circuit specific assessment, as well as professional development plans between staff and first line supervisors. The professional development of staff is considered to be a "system" within the agency and must rely on numerous key elements working in concert together including classroom training, on-the-job-training and reinforcement of clinical skills in the field between staff and the first line supervisor.

    On-the-job Training

    For a full description of the on-the-job training, please see CFSPprogress FY 2005-2009 section, page 76.

    360 Evaluation Process

    A 360 evaluation process has been implemented in the Missouri Children’s Division for first line supervisors up to Regional Directors. There were approximately 150 supervisory and management staff who participated in year one .In SFY09, Year One regions consisted of the Northwest, Southwest, and Jackson County. For FY10, Year Two regions will consist of the Northeast, Southeast, St Louis City and County. Professional Development Consultants are utilized to provide expert, objective, in person analysis for each participant. The 360 process is designed to provide a multi-source assessment, a full-circle overview of a person’s performance on the job by soliciting feedback from superiors, peers, direct reports and self on behaviors that are specific to the job assignment. The intent is to allow each individual to understand how his/her effectiveness as a subordinate, co-worker or superior is viewed by others in the organization that has the most immediate daily interaction with the person. The data generated from this process is unique to the individual and are their confidential property. They are not used for organizational personnel assessment purposes. The goal of the 360 process will be to have impact an individual’s professional growth and overall organizational effectiveness, provide well-rounded feedback from a number of sources which will increase the validity and reliability of performance judgments, promote teamwork by helping members understand how they are perceived by peers, and assist in making staff more accountable to one another because of shared input into each others performance. The feedback received will be a crucial way of understanding each employee’s unique developmental needs by providing information on what he/she needs to do to enhance career. For this latter reason it is absolutely essential that the 360 evaluation be paired with structured professional feedback and assist the employee in formulating an Individual Employee Development Plan.

    Child Welfare Practice Basic Orientation Training

    The initial in-service curriculum is titled Child Welfare Practice Basic Orientation Training (CWPT). This training is provided to new Children’s Division staff and new contracted agency staff. The initial in-service training takes place during the first several months of employment and currently includes 126 hours of classroom training provided by Children’s Division trainers combined with on-the-job training that is under the direction of the first level supervisor. The emphasis of the supervisor is on reinforcement of competencies of skills taught in the basic orientation classroom training.

    The new Children’s Services Worker, including one promoted to the position from elsewhere in the agency, is in probationary status during the first twelve months of employment. During this twelve month probationary period, the new employee receives ongoing in-service classroom training and OJT related to their job assignment which is in addition to the initial CWP Basic Orientation. A probationary worker carries a reduced caseload during this probationary period and is closely supervised in all aspects of the job to ensure that he or she is acquiring the skills necessary to adequately perform the job duties.

    There are five classes in the initial Basic Orientation curriculum:

    • Family-Centered Philosophy and Skills Training
    • Child Abuse/ Neglect Investigations/Family Assessments/ Application of Family Centered Philosophy and Skills for Intact Families
    • Expedited Permanency and the Family-Centered Out-of-Home Care Process
    • Children’s Division Systems Training
    • Reinforcement and Evaluation

    As of June 2009, a total of 20 regionalized sessions of Child Welfare Practice Basic Training have been conducted for 304 participants.

    • Setting of the training activity - Contracted facility (i.e. hotel or agency conference rooms when possible; sessions conducted regionally to provide greater availability to staff and minimize travel cost )
    • Duration category of training activity - full time (section 235.61)
    • Provider of the training - Children’s Division Professional Development and Training
    • Approximate number of days /hours of the training - A complete session is currently 126 hours over 5 weeks with approximately one -two weeks in between each for OJT skill practice activities
    • Audience to receive the training - All new Children’s Division front line social services staff and contracted agency staff providing case management
    • Description of the estimated total cost - approx. $ 310,000 per year (18-25 sessions per year conducted regionally )
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Referral to services
      • Preparation for and participation in judicial determinations
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision
      • Recruitment and licensing of foster homes and institutions

    Core In-service Modules for Front Line staff

    In addition to the CWP Basic Orientation for new front line staff, the Professional Development and Training Program offers 3 core in-service modules for staff. The in-service modules serve as the next level of skill development for staff following completion of the initial CWP Basic Orientation and OJT. The modules provide concentrated skill building with an emphasis on core areas of agency policy and best practice and include both classroom training as well as On the Job Training. This in-service structure provides ongoing education and professional development of staff throughout their first twelve months of employment while in probationary status. The modules are designed to include a supervisory component followed by the sessions for the worker. Depending on the area of specialization, staff are required to complete one or all of the sessions.

    Investigation and Assessment Core In-service

    This 4-part in-service module will provide concentrated focus on the identification and response to specific types of abuse and neglect .Various methods of instruction will be used to explore Critical Thinking Skills, Social Investigation/Assessments, Multi-Disciplinary Teams, Supervisory Consultation, Decision Making, Worker/Child/Family Safety & Risk, Interviewing Children and Adults, Documentation, Introduction to Child Advocacy Centers, Physical Abuse, Sexual Abuse, and Physical Neglect, and Skills Demonstration and Practice emphasis in conjunction with On-the-Job Training Assignments.

    As of this date in SFY 09, 2 supervisory sessions and 5 worker sessions have been conducted for a total of 82 participants. Additional sessions are planned for SFY 10.

    • Setting of the training activity - Contracted facility (i.e. hotel or agency conference rooms when possible)
    • Duration category of training activity - part time (section 235.61)
    • Provider of the training - Children’s Division Professional Development and Training
    • Approximate number of days /hours of the training - 32 hours; offered 2-4 times per year
    • Audience to receive the training - New Children’s Division front line social services staff who have been on the job for 6-12months;Front line supervisory staff attend the supervisory portion only
    • Description of the estimated total cost -$30,000 /yr
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in these training modules:
      • Referral to services;
      • Preparation for and participation in judicial determinations;
      • Placement of the child;
      • Development of the case plan;
      • Case reviews;
      • Case management and supervision

    Family Centered Services for Intact Families Core In-service

    This in-service module will provide the knowledge and skills for a CD staff person providing service to intact families. Concentrated focus will be on Engagement Skills, Safety/Risk Assessment and Re-assessment, Safety Planning, Family Support Team Meetings, Family Specific Service and Treatment Planning, Underlying Issues/Family Functioning, Case Planning and Case Documentation and Skills Demonstration and Practice emphasis in conjunction with On-the-Job Training Assignments.

    In SFY 09, 2 supervisory sessions and 5 worker sessions have been conducted for a total of 61 participants. Additional sessions are planned for SFY10.

    • Setting of the training activity - Contracted facility (i.e. hotel or agency conference rooms when possible)
    • Duration category of training activity - part time (section 235.61)
    • Provider of the training - Children’s Division Professional Development and Training
    • Approximate number of days /hours of the training -14 hours offered 2- 4 times per year
    • Audience to receive the training - New Children’s Division front line social services staff who have been on the job for 6-12months;Front line supervisory staff attend the supervisory portion only
    • Description of the estimated total cost - $ 20,000 /yr
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in these training modules:
      • Referral to services
      • Preparation for and participation in judicial determinations
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision

    Family Centered Services in Out of Home Care Core In-service

    This in-service module will focus on the knowledge and skills of a CD staff person providing family centered out of home care services to children and families. Concentrated focus will be on facilitating family support team meetings, concurrent planning/case planning, critical thinking, case documentation, written service agreements, safety assessment in biological and foster parent homes, risk assessment/re-assessment, court/permanency issues, case closure, children exiting care and cultural diversity and Skills Demonstration and Practice emphasis in conjunction with On-the-Job Training Assignments.

    In SFY 09, 2 supervisory sessions and 4 worker sessions have been conducted for a total of 54 participants. Additional sessions are planned for SFY 10.

    • Setting of the training activity - Contracted facility (i.e. hotel or agency conference rooms when possible)
    • Duration category of training activity - part time (section 235.61)
    • Provider of the training - Children’s Division Professional Development and Training
    • Approximate number of days /hours of the training -16 hours offered 2-4 times per year
    • Audience to receive the training - New Children’s Division front line social services staff who have been on the job for 6-12months;Front line supervisory staff attend the supervisory portion only
    • Description of the estimated total cost - $ 20,000 /yr
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in these training modules:
      • Referral to services
      • Preparation for and participation in judicial determinations
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision

    Older Youth Training

    This 12 hour training provides information on the core philosophy elements of the Older Youth Program. Youth development principles and assets are discussed. In this training, participants will:

    • Learn to apply youth development philosophy and identify ways to implement youth development activities. Learn what life long and permanent connections are and the importance of each
    • Learn the importance of how adolescent development relates to permanency and youth involvement
    • Develop an understanding of strategies to develop connections, how to talk to youth about connections and the link between independent living service activities and permanent connections
    • Gain an understanding of the responsibilities of case management of older youth and procedures for using the Ansell-Casey Life Skills Assessment
    • Learn how the ACLSA provides a comprehensive approach to assessment, goal planning, life skills instructions, and the evaluation of life skill activities
    • Learn how to conduct a strength/needs assessment interview and how to use the web-based Ansell Casey Life Skill Assessment
    • Understand how the Adolescent FST Guide & Individualized Action Plan and resources will assist to engage youth in their permanency and education planning

    In SFY09, a total of 14 sessions have been conducted as of this date for 188 staff. Additional sessions will continue to be provided in SFY10 as part of the ongoing training structure for new staff and will be completed by appropriate staff following CWPT Basic Orientation.

    • Setting of the setting/venue of the training activity - Agency conference/meeting space
    • Duration category of training activity - part - time (section 235.61)
    • Provider of the training - CD Training and policy staff
    • Approximate number of days/hours of the training per session -2days
    • Audience to receive the training - CD staff, foster parents, contracted providers
    • Description of the estimated total cost - approx. $16,000 per year
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Referral to services
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision

    Cultural Competency Training

    This 6 hour training is intended to help develop and enhance skills in working more effectively with children, families and communities from a variety of ethnic, political, economic, lingual, and religious backgrounds. This training will enhance a participant’s awareness of how to be respectful of one’s values, beliefs, religion, customs, and parenting styles of the families we serve. The training focuses on strategies, using strengths and empowerment based approach. In SFY09, 23 sessions have been completed as of this date for 550 staff. Additional sessions are scheduled for SFY10.

    • Setting of the setting/venue of the training activity - Agency conference/meeting space
    • Duration category of training activity - part - time (section 235.61)
    • Provider of the training - CD Training staff
    • Approximate number of days/hours of the training per session -6 hours
    • Audience to receive the training - CD staff, contracted providers
    • Description of the estimated total cost - approx. $10,000 per year
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Referral to services
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision

    Professional Ethics Training

    This 3 hour training course is intended to assist participants to:

    • Become more aware of and more sensitive to ethical issues in professional practice
    • Identify and grapple with competing arguments by examining their limitations and strengths
    • Recognize the ethical principles involved in their practice situations
    • Develop a greater understanding of the complexities of ethical decision making
    • Reach thoughtfully reasoned conclusions and apply ethical principles to professional activities
    • Clarify moral aspirations and standards and evaluate ethical decisions made with in the context of the profession

    In SFY09, a total of 2 sessions were conducted for 25 staff. Additional sessions are planned for SFY10.

    • Setting of the setting/venue of the training activity - Agency conference/meeting space
    • Duration category of training activity - part - time (section 235.61)
    • Provider of the training - CD Training staff
    • Approximate number of days/hours of the training per session -3 hours
    • Audience to receive the training - CD staff, contracted providers
    • Description of the estimated total cost - approx. $6,000 per year
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Referral to services
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision

    Adoption Training

    The 10 hour training focuses on federal laws relating to adoption, ICWA guidelines, MEPA-IEP guidelines, state laws, permanency through adoption, case planning for adoption, loss and attachment issues, impact on the child, the birth family and resource family, behavioral interviewing, child specific recruitment, writing family assessments, decision making and placement of siblings, conducting an adoption staffing, child, birth family and resource family preparation, court preparedness, and post finalization services. This training has been provided throughout the state as part of the agency’s accreditation efforts. The training will continue to be provided as part of the ongoing training efforts in SFY10 for new and existing accredited sites. A total of 17 sessions were provided in SFY09 for 269 staff. Additional sessions are planned for SFY10.

    • Setting of the setting/venue of the training activity - Agency conference/meeting space
    • Duration category of training activity - part - time (section 235.61)
    • Provider of the training - CD Training staff
    • Approximate number of days/hours of the training per session -10 hours
    • Audience to receive the training - CD staff, contracted providers
    • Description of the estimated total cost - approx. $20,000 per year.
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Referral to services
      • Preparation for and participation in judicial determinations
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision

    Legal Aspects Training

    For Children’s Division Field Staff

    Legal Aspects for Investigators
    From July 2008 through June 2009, Legal Aspects for Investigators training was conducted statewide in 20 sessions averaging 27-28 participants per session. This training is mandatory for all investigators, their supervisors and management involved in substantiating POE or in providing the administrative review to uphold or reverse the finding of POE.
    This two and one-half day training provided participants with the basics on federal constitutional law involving the rights of parents, children, perpetrators and the state, and how these rights impact (1) the CA/N hotline investigative process, (2) placing a person’s name on the Central Registry and (3) in making recommendations for the removal of children from the home. This training also included the statutory definitions of abuse and neglect and the preponderance of evidence (POE) standard necessary to substantiate a hotline investigation. The legal training portion concludes with a section on evidence and making presentations to the CANRB from a legal perspective.
    The Critical Thinking portion of the training was specifically tailored to help investigators and supervisors at key decision-making points in the investigative process: gathering information, evaluating evidence and deciding whether or not to substantiate POE.
    For July 2009 through June 2010, this training will be available in each of the four regional training areas twice per year. New staff on the investigative track will attend after completing basic as well as new supervisors and administrators who would be upholding or reversing POE when an appeal is requested. There is flexibility to meet additional needs.
    Legal Aspects - CA/N Camp
    This one-half day training has been recently developed and is being field-tested in late June 2009 on investigative supervisors in the southern region. It is a follow up training to Legal Aspects for Investigators. It is narrowly focused on applying the evidence gathered from the investigation to the legal elements of abuse and neglect and articulating how the facts support or weigh against each of the elements of either abuse or neglect in coming to a conclusion of POE. Once finalized CA/N Camp will be available to the field.
    Legal Aspects of Family Centered and Adoption Cases
    This Legal Aspects was developed within the last year and a two-day walk through was conducted in February, 2009 with 18 experienced and supervisory level field staff from across the state. The revised version was then field tested three times as a two-day training on supervisors in the southern region of the state, averaging 23 participants per training.
    The revised version provided participants with (1) fundamentals of the law, (2) how constitutional, federal and state law impact permanency planning and concurrent planning and (3) termination of parental rights.
    Beginning July 2010, the finalized version of this training will only be available for supervisors as a two and one-half day training concentrating on the fundamentals of the law and how constitutional, federal and state law impact permanency planning and concurrent planning. It will be conducted 8 times in the new training year in the four training regions.
    Legal Aspects Training to meet Circuit PIP requirements
    Two one-day trainings for staff in two circuits (26th and 30th) will be conducted this June, 2009. The content will be a modified version of the Legal Aspects training for Family Centered and Adoption workers. These materials may then also be used as a vehicle for existing staff for training in other circuits.

    For Children’s Division Central Office Staff

    Legal Aspects for Investigators overview training was conducted twice as half-day sessions for Central Office Staff averaging 10 participants per session.

    For the Children’s Division Training Unit

    Attended all or parts of the various basic and in-service trainings and reviewed the materials. Reconciled CWPT week 2 training regarding elements and findings with legal aspects training. Meetings held with supervisory staff and general recommendations made. Worked with two trainers for one and one-half days on updating and incorporating legal issues into CWPT week 3 (AC cases week).
    Three train the trainer dates have been set to work with the trainers on various legal concepts, application to the trainings and presentation in trainings.

    Training for Other Entities

    CANRB
    An individualized CANRB training was conducted for a new appointee for 2 hours in March. CANRB training will be conducted at least once if not twice before the end of June, 2009 for new appointees.
    Met with trainer and CANHU staff on preparation for CANRB trainings in late May/June 2009. Some additional material will be developed.
    The plan is to offer annual trainings for the different CANRBs to suite their schedule, especially if there are one or more hearings continued during particular sessions.
    Office of Child Advocate
    A Legal Aspects for Investigators overview training was conducted as a five and one-half hour training for the State’s Child Advocate and three of his staff.
    CASA
    A thirty minute presentation was made to the executive board of CASA at their annual meeting on Permanency Planning.
    Judicial College
    A one hour presentation was made to the judges at each of the two Judicial Colleges on Permanency Planning and TPR, focusing on a check list approach for the judges to get to termination of parental rights.
    Division of Legal Services
    On May 21, 2009, a fifty minute program on Permanency Planning and TPR will be conducted at the annual continuing legal education program for the DLS attorneys.
    JCIP - Juvenile Court Improvement Project
    1. A one hour training on Permanency Planning and a one hour training on Child Welfare Law was conducted in St. Louis City as part of a one day CIP multidisciplinary training arranged by the 23rd Judicial Circuit.
    2. Participated in the committee developing the curriculum for a two day regional training for juvenile officers, children’s division staff, Guardians ad litem and other participants centering on engaging families through the family support team process. This program is in draft form. Focus is on constitutional, federal and state laws impacting concurrent planning. The plan is for regional trainings statewide to cover at least seven trainings over a three to four week period of time.

    Community Partners

    Use of some of the Legal Aspects for Investigators materials and assistance in training for a multidisciplinary training to include community partners in the 5th circuit is being developed at this time for this summer. The training would then be available to assist circuits in explaining to community partners the impact of the Jamison decision on CA/N investigations.

    Development of a Jackson County training was discussed with the regional director, the acting chief juvenile officer and an assistant prosecutor, should the regional director choose to act on it. This could include Children’s Division staff, law enforcement and assistant prosecutors regarding CA/N elements, burdens of proof and standards of evidence as well as some training for CD staff on testifying in criminal cases and juvenile cases when CD unsubs the hotline report but the juvenile officer or prosecutor chose to file on it.

    STARS Pre-Service, In-Service, and Spaulding Train the Trainer

    Training for resource families continues to be offered and conducted on a regular basis utilizing the training curriculum purchased from the Child Welfare League of America (CWLA). Foster PRIDE/Adopt PRIDE curriculum produced by CWLA is a part of Missouri’s preparation of resource families which is called STARS, which means Specialized Training, Assessment, Resources, Skills, and Support. Staff training and Development provides the STARS Train the Trainer courses for local training teams. The local training team consists of a service worker, foster and/or adoptive parent and a supervisor of the team. The service worker and the foster/adoptive parent co-trains. The service worker also is responsible for conducting the family assessment need for licensure.

    The CWLA curriculum has 12 in-service modules providing over 100 hours of training. Train the Trainer courses are conducted for the same local training teams noted above. These courses are conducted throughout the state.

    In addition to STARS, adoptive parents are required to attend 12 hours of training, specific to adoption, and prior to licensure. The above teams are also trained to provide the Spaulding "Making the Commitment to Adoption" course.

    All the above STARS and Spaulding Train the Trainer courses include contractors who provide the training and assessment of resource families. A total of 8 sessions have been conducted for 132 participants who have attended STARS Pre-Service, In-Service, and Spaulding Train the Trainer as of this date in SFY 09.Additional sessions are scheduled for SFY10.

    • Setting of the setting/venue of the training activity - Contracted facility or agency conference when possible
    • Duration category of training activity - part - time (section 235.61)
    • Provider of the training - Children’s Division Professional Development and Training
    • Approximate number of days/hours of the training per session - STARS Pre-service 2 weeks with one week in between sessions; STARS In-service (12 modules conducted as follows: modules 1-6 one week; modules 7-12 one week; Spaulding 3 days
    • Audience to receive the training - Teaching foster parents, CD staff and contracted providers who provide local STARS/Spaulding training and assessment for prospective resource families
    • Description of the estimated total cost - approx. $100,000 for all trainings/multiple sessions per year
    • This training is allowable as a Title IV-E activity to be matched at a 75% FFP rate and will be allocated by Missouri’s IV-E penetration rate. The purpose of this training is to prepare foster parents for caring for children in the custody of the Children’s Division to be placed and cared for in their homes. The following activities are addressed in this training:
      • Referral to services
      • Preparation for and participation in judicial determinations
      • Placement of the child
      • Development of the case plan
      • Case reviews
      • Case management and supervision
      • Recruitment and licensing of foster homes and institutions

    Professional Development Collaboration

    Over the past year, the Children’s Division has continued to move forward with collaborative efforts to strengthen the professional development and practice of agency staff. The feedback and evaluation from the training opportunities, both in the classroom, as well as in the field, has been positive overall. Staff indicate this professional development has improved individual knowledge and skill, but it has also provided a means to strengthen strategic planning and ongoing collaboration at the local level.

    One of the primary partnerships that has continued is the Office of State Courts Administrator and Children’s Division Collaborative. OSCA and the Children’s Division continue to jointly develop and deliver comprehensive training for Juvenile Court staff and Children’s Division staff on child protection and juvenile court programs that impact policy and practice in both agencies.

    For FY10, Advanced Facilitation Skills Training will be offered in 9 locations throughout the state. A Family Engagement Training Conference is also being scheduled for Children’s Division, Juvenile Court staff, and community partners.

    In SFY09, the following joint training was provided for Children’s Division and Juvenile Court staff:

    Accreditation

    See Five Year Progress Sectionon Accreditation.

    Courtroom Skills Training for Good Child Welfare Practice

    This training focuses on preparing for court, professionalism in the courtroom, testifying in court, and legal terminology. Proper courtroom procedure including professionalism, understanding the role in the court process, knowing how to prepare and read court orders, knowing the required contents of a petition, preparing for testimony, understanding basic evidentiary rules, handling cross-examination, knowing how to be responsive to questions as well as understanding the statutory criteria for TPR cases are covered. As of this date in SFY 09, 2 sessions have been conducted for 40 participants. Additional sessions are planned for SFY10.

    Collaboration Workshop

    Because of the successful outcomes with this workshop in previous years, the Collaboration Workshop continues to be provided. In SFY09, new circuits were trained to address the challenging relationships that exist between local court personnel and Children’s Division personnel. Future mini-collaboration workshops are planned for FY10

    • Teams from selected circuits will participate in a training program which focuses on teamwork, collaboration and communication
    • Teams are selected from a pre-screening questionnaire on the existence and effectiveness of collaboration and communication between the two entities within their circuit
    • Follow-up evaluation is implemented 2 months following the workshop to measure the existence and effectiveness of collaboration and communication between each circuit’s courts and the Children’s Division
    • The findings of the follow-up evaluation help to determine the need for continued multidisciplinary training focusing on teamwork, collaboration and communication with local circuit teams

    In SFY 09, 8 sessions have been conducted for 195 participants.

    • Setting of the training activity - Contracted facility
    • Duration category of training activity - part - time (section 235.61)
    • Provider of the training -Office of State Courts Administrator and Children’s Division Professional Development and Training
    • Approximate number of days /hours of the training per session - 1 day
    • Audience to receive the training - Children’s Division staff and Juvenile Court staff
    • Description of the estimated total cost - approx. $50,000 per year
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Referral to services
      • Preparation for and participation in judicial determinations
      • Placement of the child
      • Development of the case plan
      • Case management and supervision

    Supervisor Training and Initial In-Service Training

    The Children’s Division, in partnership with the Department of Social Services Human Resource Center, has developed a comprehensive skills based training structure for front line supervisors. The structure requires new CD supervisory staff to complete the following initial in-service training within their first year:

    • Basic Orientation Supervisory Skills Training 40 hours
    • Children’s Division Supervisor Training 39 hours

    Competency areas such Leadership, the parallel process of being strengths based and solution focused, decision making, group supervision, time management, critical thinking, case consultation, worker development and performance, ethical and liability issues, teamwork, crisis intervention, mediation, and facilitating change are the focus of the training.

    As of this date in SFY 09, 7 sessions of BOSS Training have been provided to 173 participants. Additional sessions are planned for SFY10.

    As of this date in SFY09, 4 sessions of Children’s Division Supervisor Training have been provided to 51 first line supervisors. Additional sessions are planned for SFY10.

    Ongoing In-Service Training

    In SFY09, the Children’s Division and HRC continued to offer a variety of in-service training modules to provide supervisors and managers professional development opportunities beyond the initial first year training. Examples of the competency based modules offered include Art of Negotiation, Effective Discipline, Effective Meetings, Employee Motivation, Managing Diversity Problem Solving, Teamwork, and Turning Conflict into Collaboration .These in-service modules will continue to be offered in SFY 10.

    • Setting of the training activity - Contracted facility (i.e. hotel)
    • Duration category of training activity - full-time during the initial in-service training which will have both classroom and OJT; part-time for the ongoing /continuing in-service modules (section 235.61)
    • Provider of the training - Children’s Division Professional Development and Training Unit and the Human Resources Center, Dept. of Social Services
    • Approximate number of days /hours of the training - 40 hours of BOSS and 39.5 hours of CD Supervisory initial in-service training with weeks of OJT in between classroom sessions. Ongoing in-service modules are approx 1-2 days in length. Multiple sessions will be conducted each year
    • Audience to receive the training - Children’s Division supervisors.
    • Description of the estimated total cost - approx. $226,000 per year. Cost includes Children’s Division sessions and the Human Resource Center management course offerings
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our CAP and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Development of the case plan
      • Case reviews
      • Case management and supervision

    Domestic Violence Training

    In SFY-09, the Children’s Division, in conjunction with the Missouri Coalition against Domestic Violence (MCADV), conducted 8 sessions of Domestic Violence training for new Children’s Division and Family Support Division staff. This will continue to be offered in SFY10. A total of 257 staff have attended the training as of this date.

    • Setting of the training activity - Contracted facility (i.e. hotel)
    • Duration category of training activity - part - time (section 235.61)
    • Provider of the training - Coalition Against Domestic Violence staff and Children’s Division Professional Development and Training
    • Approximate number of days /hours of the training per session - 1 day
    • Audience to receive the training - Children’s Division and Family Support Division staff
    • Description of the estimated total cost - approx. $5,000 per year. (Grant funding secured through MCADV utilized to cover majority of training expenses)
    • Federal Title IV-E funding is allowable as one of the funding sources for this training and would be distributed based upon our Cost Allocation Plan and the results of the Random Moment Time Study. The following activities are addressed in this training:
      • Referral to services
      • Preparation for and participation in judicial determinations
      • Placement of the child
      • Development of the case plan
      • Case management and supervision