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Mille Lacs County
Minnesota Child and Family Service Review
Program Improvement Plan


I. General Information
 
 
County Agency Name:

Mille Lacs County Family Services

Address: Courthouse Square Building

635 2nd Street SE

MIlaca, MN 56353

Telephone Number: 320-983-8208

 
County Person Primarily Responsible for PIP:

Suzanne Lelwica

E-mail Address:

suzanne.lelwica@co.mille-lacs.mn.us

 
Telephone Number: 320-983-8208

 
DHS Quality Assurance Contact Person:

Steve Johnson

E-mail Address:

steve.h.johnson@state.mn.us

Telephone Number: 763-497-0156

To be completed by DHS:

Date Draft PIP Submitted by County: 8/06/08

Date PIP Approved: 09/09/08

Due Dates for Quarterly Updates: 12/31/08, 3/31/09, 6/30/09 and 9/30/09

Date of PIP Progress Review(s): see due dates for Quarterly Updates

PIP Completion Date: 10/1/09


II: Program Improvement Plan Narrative *Detailed instructions and additional information on the following narrative is available in the PIP instructions*

Introduction and Performance Summary: Include when the MnCFSR was completed and a summary of performance in outcomes, performance items and national standards.

 The Minnesota Department of Human Services (DHS) conducted a Minnesota Child and Family Service Review of the child welfare system in Mille Lacs County in November 2007. Mille Lacs County met five of six national standards, including recurrence of maltreatment, incidence of child abuse/neglect in foster care, length of time to achieve reunification, stability of foster care placements, and length of time to achieve adoption. The agency did not meet the national standard for foster care re-entry. The onsite review consisted of an intensive examination of six randomly selected cases involving children who received child welfare services between September 2006 and November 2007. Two in-home and four placement cases were reviewed. Records selected for the review were presumed to be representative of agency practice, with recognition that ratings were based on a relatively small sample of cases measured against high performance standards. The county had the strongest findings in Safety Outcome 1: Children are, first and foremost, protected from abuse and neglect; Safety Outcome 2: Children are safely maintained in their homes whenever possible and appropriate; Permanency Outcome 1: Children have permanency and stability in their living situations; Permanency Outcome 2: The continuity of family relationships and connections is preserved for children; and Well-being Outcome 2: Children receive appropriate services to meet their educational needs. Performance items related to Well-being Outcome 1: Families have enhanced capacity to provide for their children's needs, were the most often rated as areas needing improvement. Themes Identified: The following themes emerged from information compiled from the Minnesota Child and Family Service Review in Mille Lacs County: • Findings from this review identified the agency's child safety response, placement prevention practices, and timely permanency planning as practice strengths. • The agency has made considerable efforts in building and maintaining positive and effective working relationships with stakeholders. The strength of these relationships supports the agency's efforts to achieve safety, permanency and well-being outcomes for children. • Caseworkers’ first-hand observations and direct contact with families are critical for monitoring risk, safety and service needs. The ratings on a number of performance areas were negatively impacted by inconsistent caseworker visits with parents. More frequent caseworker visits would support improved outcomes for children and families. • The agency will benefit from continued efforts toward coordination on cases in common with the tribe to achieve positive outcomes for children. While representatives from both agencies expressed optimism, they also acknowledged the need for ongoing efforts to understand, nourish and sustain relationships. As a result, a stronger child welfare system will support improved outcomes for American Indian children and families.

Cross Cutting Themes Identified During MnCFSR: Provide a description of crosscutting themes and systemic issues that affect multiple areas of the county’s performance.

 Themes Identified: The following themes emerged from information compiled from the Minnesota Child and Family Service Review in Mille Lacs County: • Findings from this review identified the agency's child safety response, placement prevention practices, and timely permanency planning as practice strengths. • The agency has made considerable efforts in building and maintaining positive and effective working relationships with stakeholders. The strength of these relationships supports the agency's efforts to achieve safety, permanency and well-being outcomes for children. • Caseworkers’ first-hand observations and direct contact with families are critical for monitoring risk, safety and service needs. The ratings on a number of performance areas were negatively impacted by inconsistent caseworker visits with parents. More frequent caseworker visits would support improved outcomes for children and families. • The agency will benefit from continued efforts toward coordination on cases in common with the tribe to achieve positive outcomes for children. While representatives from both agencies expressed optimism, they also acknowledged the need for ongoing efforts to understand, nourish and sustain relationships. As a result, a stronger child welfare system will support improved outcomes for American Indian children and families.

Description of Overarching Strategies: Provide a description of program improvement strategies and identify strengths or promising practices that can be effective in making improvements in multiple areas. Include discussion on staff orientation/training in relation to the MnCFSR and Program Improvement Plan.

Mille Lacs County Family Services will continue to implement case reviews to monitor compliance with rules, laws and policies. Case reviews will be conducted monthly with additional case reviews using the Quality Assurance Tool Kit to be completed on a quarterly basis. All staff will be provided a copy of the tool kit and will be presented with information from DHS on the utilization of the tool kit.

Description of Methods of Measurement/Monitoring: Provide a description of the evaluation approaches that will be used for measuring improvement, e.g. Qualitative Case Review System and review of relevant SSIS reports.

Mille Lacs County Family Services will review reports in SSIS to evaluate and monitor staff compliance with requirements. Quarterly case reviews using the quality assurance tool kit will be used to monitor cases. (12 cases)

Plan for the Development and Dissemination of the PIP: Provide a description of the process used for developing and soliciting input on the PIP, e.g. who was involved, and the plan for dissemination of the PIP to agency staff and community partners.

Mille Lacs County will prepare a Program Improvement Plan to address items aggregately rated as Area Needing Improvement, which are identified in Tables 6 and 7 of the Appendix. Table 6 includes raw numbers and Table 7 includes overall percentages. Performance ratings from the Minnesota Child and Family Service Review will provide a baseline for measuring ongoing quality improvements. The strategies for change and improvement of practice outlined in the county’s plan will focus the agency’s efforts on improving outcomes for the children and families they serve. Mille Lacs County should be encouraged that the review recognized systemic strengths and areas of child welfare practice that will provide a strong foundation for program improvement planning designed to promote positive outcomes for children and families. Mille Lacs County Family Services administrative staff have counsulted and determined that the current method of monthly case reviews and adding the quarterly quality assurance tool kit reviews will assist in the continuum of monitoring for compliance. DHS staff and a representative from the Mn Child Welfare training system will assist the county in identifying appropriate trainings and steps which are included in the PIP. The PIP will be shared with the local CJI committee and also available to the members of the Mille Lacs County multi-disciplinary child protection team which includes a majority of the local stakeholders.


III. Matrix


PERMANENCY OUTCOME 1: Children have permanency and stability in their living situation
Item 5: Foster care re-entries
Performance at time of review : 100%

Performance Goal : see National Standard Indicator

Issues noted in the final report: In three cases, children entered foster care during the period under review. In each case this was the child’s sole entry into foster care and there was no re-entry. The agency provided services to help ensure successful reunification and prevent re-entry into foster care, including the use of trial home visits (THV). This item is being addressed due to not meeting the National Standard Indicator for this item.

Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisors

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

Case managers will utilize the SDM Family Reunification Assessment risk tool to aide in evaluating safety factors before reunification.

In order to reduce unnecessary foster care placements and foster care re-entries, the Placement Committee will screen all cases for the appropriateness of Family Group Decision Making Services.

July 2009

Monthly Case Reviews/ Quality Assurance Toolkit and review Placement Committee meeting minutes and notes.

 

PERMANENCY OUTCOME 1: Children have permanency and stability in their living situation
Data Indicator: Foster Care Re-Entries

National Standard: 8.6%

County Performance 2006: 25%

Performance Goal : 15%

Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisor

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

See Item #5

July 2009

Quarterly case reviews

 

WELL-BEING OUTCOME 1: Families have enhanced capacity to provide for their children’s needs
Item 17: Needs and services of child, parents, foster parents

Performance at time of review : 66.7%

Performance Goal (%): 100

Issues noted in the final report:

Children:

In all cases, children’s needs were assessed and timely, appropriate services were provided. To assess needs, the agency used a combination of formal and informal assessment strategies. Examples of services for children included social activities and social skills groups. It was noted that Child Well-being Tools were completed in many cases.

Mothers:

In five cases, the mothers’ needs were formally and informally assessed, and services were provided to meet those needs. Examples of services and other assistance included chemical dependency assessments, chemical dependency treatment, random urinalysis testing, in-home skills, daycare, employment, domestic violence prevention education, employment support, clothing and food. The agency conducted initial, ongoing assessments of their needs and responded appropriately. Reviewers noted the completion of SDM Family Needs and Strength Assessments.

In one case rated as an Area Needing Improvement, there were inadequate initial or ongoing assessments of the mother’s needs. The agency did not engage the mother in an assessment until four or five months into the case, which resulted in delaying her receipt of needed services. It should be noted that the mother had lost permanent legal and physical custody in a different county and the Tribe had initiated the current legal action in Tribal Court. However, during the past three months the mother’s needs have been assessed and services provided.

Fathers:

In four cases, the father’s needs were adequately assessed; and in three of those cases, services were provided. There were examples of formal and informal assessments being completed. In one case, after completing the assessment, the court relieved the agency of the responsibility for providing services to the father. In the one case rated as an Area Needing Improvement, there was no ongoing assessment of a non-custodial father’s needs. It is believed that the newly-assigned worker did not have knowledge that the father had previously expressed interest in maintaining contact with this child and working with the agency.

Foster Parents:

In all cases, the foster parents’ needs were assessed and services provided. Reviewers learned that all needs were met by the agency to help support the foster parents and ensure stability of the children’s placements. Agency caseworkers were determined to be responsive and available to the foster parents.

Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisor

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

(1) Case managers will ensure that the needs of all family members will be assessed within 30 days of case opening. Case Managers will conduct informal assessments when they meet with children, parents and foster parents.

(2) Case managers will utilize appropriate assessment tools, including: SDM-Safety Assessment, SDM-Family Risk Assessment, SDM-Family Needs and Strengths Assessment, SSIS-Child Well-Being Tool to assess family needs and provide appropriate services.

(3) Supervisor will review the following training tools with case managers:

*PIP TIPS Item 17: Assessing Needs and Services” with case managers *PIP TIPS Item 18: Involving Families and Children in Case Planning *PIP TIPS: Worker Visits with Parents *PIP TIPS: Involving Fathers *PIP TIPS: Worker Visits with Children

July 2009

Quarterly case reviews

 

WELL-BEING OUTCOME 1: Families have enhanced capacity to provide for their children’s needs
Item 18: Child and family involvement in case planning

Performance at time of review (%): 66.7%

Performance Goal (%): 100

Issues noted in the final report: In all cases, the agency attempted to engage age-appropriate children, mothers and fathers in case planning. There were examples of the workers conducting case planning meetings with families, seeking their input for the plans. It was also noted that workers were using case plans as part of regular meetings with families to evaluate progress on their plans.


Two cases were rated as an Area Needing Improvement because there was no current and/or signed case plan in the file. Appropriate engagement of families took place in each case.

Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisor

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

Case managers will ensure that all appropriate family members (e.g. parents and age-appropriate children) will be engaged in the development of their case plans and will sign their case plans. If a family member is unwilling or unable to sign the plan, refuse to participate in the plan development, the worker will document the reason(s).

(2) If a family refuses voluntary case management services for more than 30 days, and a CHIPS petition is not filed, the case manager will close the case.

(3) Supervisor will review the following training tools with case managers:

*PIP TIPS Item 17: Assessing Needs and Services” with case managers *PIP TIPS Item 18: Involving Families and Children in Case Planning *PIP TIPS: Worker Visits with Parents *PIP TIPS: Involving Fathers *PIP TIPS: Worker Visits with Children

July 2009

Quarterly case reviews

 

WELL-BEING OUTCOME 1: Families have enhanced capacity to provide for their children’s needs
Item 20: Worker visits with parent(s)

Performance at time of review : 50%

Performance Goal (%): 100

Issues noted in the final report: The frequency of contact between parents and workers ranged from weekly to monthly in response to the needs and risks of the family. Parents reported that agency caseworkers cared about their families and were helpful. Reviewers heard how a resistant parent and a caseworker developed a trusting working relationship that resulted in the parent cooperating with needed services.

In one case rated as an Area Needing Improvement, both parents were seen less than monthly; there was a need for more frequent contact. In a second case, there were no efforts to contact a non-custodial father who desired to maintain contact with his child and the agency.

Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisor

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

See previous item #17, and #18. Also, frequency of worker visits will be matched to the parent’s needs for visits and the visits will be substantive.

July 2009

Quality Assurance Toolkit

 

WELL-BEING OUTCOME 3: Children receive adequate services to meet their physical and mental health needs
Item 23: Mental/behavioral health of the child

Performance at time of review (%): 83.3

Performance Goal (%): 100

Issues noted in the final report: • Item 23: Mental/behavioral health of the child. This item evaluated whether children’s mental/behavioral health needs had been appropriately assessed, including the completion of required children’s mental health screenings, and whether services designed to meet those needs were provided. Agency caseworkers typically completed required mental health screenings. The identified mental health needs were met through individual counseling, social skills groups at school, and specialized services. In one case rated as an Area Needing Improvement, the required children’s mental health screening was not completed although the child met eligibility for the screening. However, the child was an infant and there were no unmet mental health needs identified during the case file review.

Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisor

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

Supervisor will review the mental health screening requirements with staff and ensure the required screenings are completed on a timely basis.

July 2009

Quarterly case reviews and staff meeting minutes that document the CMH discussion and requirements.

 

SYSTEMIC ISSUES:
County Self Rating (from Self Assessment): Mille Lacs County Family Services found that most, but not all, of the exploratory issue practices or requirements are in place and most function at an adequate or higher level in some areas and in other areas all of the exploratory issue practices or requirements are in place and all are functioning at an adequate or higher level.
Goal: Complete 12 case reviews annually
Issues noted in the final report: Quality Assurance System: Mille Lacs County has a number of informal and formal quality assurance practices in place. Current practices include supervisory, screening team and staff meetings. The agency would benefit from the expansion of their quality assurance system to evaluate qualitative measures through internal case reviews, with a focus on supporting practices most likely to result in positive outcomes for children and families.
Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisor

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

DHS will provide Quality Assurance Toolkit training and support. Supervisor will complete Quality Assurance case reviews and report results to DHS.

July 2009

Quarterly Case reviews

 

SYSTEMIC ISSUES:
County Self Rating (from Self Assessment):

Goal:

Issues noted in the final report: SYSTEMIC FACTORS


The self assessment of the county’s child welfare infrastructure provided descriptions and ratings of strength or area needing improvement on eight systemic factors. The Minnesota Child and Family Service Review further examined these factors through stakeholder interviews and the onsite case review. Many systemic issues were previously identified and addressed as they applied to specific performance items. Observations listed here summarize some of the findings on these systemic factors.


The following systemic factor(s) contributed to positive case findings:


Agency Responsiveness to the Community: The agency has made considerable efforts to engage a range of community stakeholders in an attempt to address the ever-changing family needs within Mille Lacs County. Stakeholders are invited into the agency, which helps to provide input and feedback regarding practices and policies that directly affect children and families.


Staff and Provider Training: The agency prioritizes staff training, particularly at a time when new worker training is critical. The agency evaluates service needs and makes arrangements for specialized staff training (e.g. forensic interview training), to ensure adequate staff resources for specialized tasks or services.


Case Review System: There are strong practices noted, including good working relationships and communication with stakeholders associated with district court. The agency continues to work with tribal stakeholders on strategies for achieving culturally recognized permanency for American Indian children.


The following systemic factor(s) should be addressed in the development of the Mille lacs County Program Improvement Plan:


Quality Assurance System: Mille Lacs County has a number of informal and formal quality assurance practices in place. Current practices include supervisory, screening team and staff meetings. The agency would benefit from the expansion of their quality assurance system to evaluate qualitative measures through internal case reviews, with a focus on supporting practices most likely to result in positive outcomes for children and families.


Person(s) responsible for implementing action steps and monitoring progress: Social Service Supervisor

Action Steps

Date to be Completed

Methods of Measurement/Monitoring

Quarterly Updates

1. Continue monthly case reviews

2. Continue Supervisory and Staff Meetings

3. Continue Utilizing juvenile Treatment Screening Team

July 2009

Monthly case reviews and quarterly case reviews utilizing the QA Toolkit. Review Juvenile Screening Team notes and minutes for results.

 

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