Statistical and Supporting Information

During the CY 2007, 53 children exited custody from CD and were transferred to DYS. During the CY 2008, 52 children exited custody from CD and were transferred to DYS. This information is derived by matching exits from the alternative care population with entries into the state’s Juvenile Justice System. Both information systems used the same unique identifier for child/youth served.

CD collected information regarding children who are adopted from other countries and who enter into state custody as a result of the disruption of a placement for adoption or the dissolution of an adoption. Two (2) children who were adopted internationally entered state custody as a result of disruption of a placement for adoption or the dissolution of an adoption during FY2008.

The two (2) children’s summaries are as follows:

• The plan for one child is family reunification, but the child does not want to reunify. The concurrent plan is independent living. The child entered foster care due to allegations of abuse from the adoptive father and mother; and
• The plan for the other child is termination of parental rights/adoption. The family voluntarily relinquished custody after attempting to re-adopt the child within the adoption agency. The child entered residential care due to behavior problems

See Inter-Country Adoption in the Annual Permanency section for more information.

Last Five Years Progress (FFY 2005-2009)

During FFY05- FFY07, worker visits data was not captured in the information system. However, in January 2008, full implementation of case management in FACES occurred, allowing automated tracking of caseworker visits. As a result, CD was equipped to monitor worker visits in a more efficient manner. Prior to this, supervisory oversight was the primary method for assuring appropriate worker visits occurred.

In FFY07, a baseline of performance on worker visits with children was established. The data system utilized by CD at that time did not allow for the tracking of caseworker visits. Therefore, in order to meet the requirement to report caseworker visit data, the division provided a manual count through a case review process beginning July 1, 2007. CD sampled the Legal Status 1 (LS 1) population or children in the care and custody of the division. The review also included children case managed by the PBC and the Specialized Case Management contracts. The sample size of 15,253 children was based on a year’s population beginning June 1, 2006 and ending May 31, 2007. The reviews included children in LS 1 status on October 1, 2006 to June 30, 2007. The sample size of 375 was calculated as follows:

In FFY07, for the baseline, data indicated that 209/375 (56%) children received caseworker visits each and every month the child was in care. 93% of those visits were in the child’s placement.

In November 2008, Missouri was granted an extension by ACF for submission of this report, with a due date of December 31, 2008. In addition, permission was granted for the report to be based on a random sample of children based on a previously federally approved selection method. This allowed Missouri to rectify data entry and report integrity concerns prior to final report submission. In November, a preliminary report was obtained resulting in case reviews and data entry corrections during the months of November and December under the direction of the QA Unit Manager and Regional QA Specialists.

Data for the FFY08 report were obtained exclusively from Missouri’s SACWIS compliant information system (FACES). Since the first three months of this report period (October, November and December 2007) were prior to FACES implementation for some circuits, case reviews were completed and visit data was entered retroactively based on documentation and worker visits forms found in case files during QA reviews.

The sample size for the report was based on the 14,611 children or 100 percent of the foster care population for the entire year, from October 1, 2007 to September 30, 2008. The sample size of 375 was calculated as follows:

To determine the data for caseworker visits with children, using the randomly sampled 375, CD collected the following data based on the child being in CD’s custody for at least an entire month for the 12-month period; 1) the number of children visited each and every calendar month they were in foster care; 2) the total number of visit months for children who were visited each and every month they were in foster care, and 3) the total number of visits which occurred in the child’s residence. If a child was in care the entire 12 month period but was visited eleven of those months, the child was not included in the percentage of children in foster care who were visited during each and every calendar month. We also calculated the number of visits occurring in the residence (placement) of the child. Additionally, for comparison purposes, these calculations were stratified by the three identified age groups.

In FFY08, the Children’s Division determined that 177 / 375 (47%) children received caseworker visits each and every month the child was in care. 91% of those visits were in the child’s placement.

In FFY09, the Children’s Division monitors worker visit compliance through a web-based report using data from the SACWIS information system. This report has proven to be instrumental in improving awareness and data entry efforts on caseworker visits. Based on this web report, in October 2008, caseworkers had visited children 49% of the time, but this improved to 85% in April 2009.

Worker Visit Plan for Next Five Years (FFY 2010-1014)

Mobility is a project currently being considered as one method for improving data entry efforts for worker visits. Mobility, including the use of laptops and wireless internet cards, would facilitate timely and accurate entry of data. This option is still under discussion at this time.

In addition, as previously mentioned, a new automated report was made available on November 20. 2008, and is available to all staff through FACES. The report is designed to help managers and staff monitor individual case frequency of visits based on state policy requirements.

The Children’s Division is actively addressing data entry challenges and identifying system enhancements needed to better capture worker visits with children data. Workers can currently enter the date and location the visit took place with the child. A policy memorandum was sent on April 1st, 2008 outlining the data entry process, and again on November 20, 2008 to reinforce visit policy and to introduce the new management report discussed above.

Currently, workers use paper forms to document the quality of visits. The Checklist for Worker/Child Visits, Form CD-82, is utilized for documenting the date, time, location of the visit, who was present, safety and case-related issues discussed during the visit. Issues such as the child’s perception of the family needs, if the child has any feelings of guilt or blame for the family’s separation, grief or loss, the child’s adjustment to their new school (if applicable), health issues, court and case goal issues, the child’s participation and feelings towards treatment, and how the family visits are going, etc. Additional information system enhancements are being considered for documenting these quality components of worker visits in a structured manner which may potentially eliminate the need for paper documentation.

While FACES allows for automated recording by caseworkers, the reporting methodology and data collection will remain relatively constant through 2011.

The Children’s Division will begin reporting worker visits on the full foster care population for FFY 2009 and has established incremental goals in order to achieve 90% compliance by 2011 as follows: FFY 2008: 60%; FFY 2009: 70%; FFY 2010: 80%; FFY 2011: 90%.

The Children’s Division has developed a strategic plan to improve performance for caseworker visits with children in order to meet the specified goals. See Worker Visits Strategic plan in the Other PI Requirement section.

Last Five Years Progress (FFY 2005-2009)

Following the baseline in FFY07 and subsequent submission of data on worker visits for FFY08, the Children’s Division became aggressively involved in increasing awareness of the importance of frequent quality caseworker visits with children and the need to improve efforts to document the visits which were occurring.

In April and November 2008, policy memorandums were sent to all CD staff specifically focusing on worker visits with children. These memorandums remain available on the CD Intranet for referencing as needed.

A technical assistance meeting was held on November 5, 2008 with a National Resource Center consultant to review current policies and procedures related to worker visits with children. This meeting was attended by Central Office and Regional managers, program development specialists, training unit staff, QA and QI managers, the CFSR Coordinator, and field supervisors. The purpose of the initial meeting was to review current policy and practice and to strategize on ways to improve the quantity and quality of visits with children. Federal and State requirements for worker visits were reviewed. The significance of worker visits in directly impacting child permanency, safety and well being was discussed. Children’s Division policies and procedures were reviewed, including expectations for the agency, casemanagers, supervisors and for tracking quality and quantity of visits. As a result of this meeting, a strategic plan for improving worker visits with children was developed.

The quarterly CQI In Focus newsletter has featured worker visits on several occasions. It has been used to map out succinct steps in entering the visit into our information system.

Statewide and regional strategic plans were developed and are underway. These strategic plans are targeted to improve performance for caseworker visits with children in order to meet the specified goal. Specific information regarding the strategic plans to improve worker visits is discussed further below.

Regions have initiated creative strategies for emphasizing the importance of worker visits. For example, one field manager set up a scenario at a staff meeting where 10 volunteers represented 10 children. Each volunteer was provided a child’s "story" regarding all the events occurring during the last month. Then he would demonstrate what it would look like if 70% of the children on his caseload was visited. So, seven of the volunteers remained silent because the caseworker was already aware of their "story" but the three children who were not visited, read their "story" and the audience was amazed at all the information they missed out on this month by not seeing those three children. It was very powerful to the audience and drove home the importance of workers visiting with children.

A new automated report was made available on November 20. 2008, and is available to all staff, including private agency casemanagement staff, through FACES (Missouri’s SACWIS information system). The report is designed to help managers and staff monitor individual case frequency of visits based on state policy requirements. CD staff and managers at all levels can view and monitor data at the aggregated state and regional levels. Individual case managers and their respective managers can monitor visits at the case level.

This screen shot demonstrates the Regional View of Caseworker Visits performance for March 2009 on the newly developed state monitoring report discussed above.

In April 2009, a reference guide was developed to assist staff in understanding data entry requirements for documenting worker visits. A dramatic improvement in data entry efforts was achieved as a result of this state report and increased awareness on how to accurately enter worker visits information. This reference guide remains available on the Intranet for continued staff self-instruction or reinforcement as needed.

This bar chart demonstrates regional performance and/or data entry improvements made between October 2008 and April 2009 after implementation of the state worker visit report and reference guide.

State Policy on Worker Visits with Children:

Current Children’s Division policy requires workers to meet face to face with children in foster care the next business day following placement when possible and a minimum of two visits per month, no less than seven calendar days apart. The visit the next business day and at least one visit per month thereafter must occur in the placement setting.

Caseworkers must continually assess the children, through visits in the placement setting, for the child’s :

• Safety in the placement
• Reaction to separation from his/her family
• Perception/understanding of the problem and what they would like to see happen
• Adjustment to the placement

The caseworker utilizes the CD-82 Checklist for Worker/Child Visits during visits with the child in the placement setting to address, as appropriate, the following issues:

• Child’s perception of family needs
• Child’s feelings of guilt or blame
• Child’s loss and grief issues
• Child’s perception of familial and individual strengths
• Child’s desire for future placement
• Child’s adjustment to current placement and school setting
• Child’s participation in and feelings toward treatment and educational services offered
• How child’s perception may differ from actual events
• Child’s feelings of safety in the placement home
• Case goal and progress toward this goal

The Children’s Division requests that all children placed through the ICPC in another state, receive contact according to Missouri standards, if possible, but at a minimum of once per month in the placement setting. It is also the expectation of our staff to have contact with children placed through ICPC in Missouri to be seen according to policy for Missouri children, which is twice per month with at least one visit in the placement setting each month.

The Children’s Division will begin reporting worker visits on the full foster care population for FFY 2009 and has established incremental goals in order to achieve 90% compliance by 2011 as follows: FFY 2008: 60%; FFY 2009: 70%; FFY 2010: 80%; FFY 2011: 90%.

Statewide and Regional plans have been developed to improve performance for caseworker visits with children in order to meet the specified goals.

See Chafee Section for write-up on Education and Training Vouchers

The Missouri Children’s Division does not grant licensing waivers. However, we grant variances for specific reasons for a specific timeframe. For example, in the case of non-safety licensing standards, maximum capacity or age range issues, a variance may be granted for a time limited period not to exceed the current licensure period.

Please see the Interstate Compact Act write-up in the Annual Practice Section.