Alabama's comprehensive child welfare system reform.
While the ruling has garnered national attention, the child welfare system created and maintained in Alabama is the story. The change of philosophy, employee training and development, caseload standards, citizen oversight committees, performance measurement, all undergirded with improved technology and additional financial and personnel resources, represents an epic metamorphosis. The work of employees, advocates, service providers, foster families and government officials committed to change and willing to abide by the law of the harvest--you reap what you sow; you reap later than you sow; and you reap more than you sow--has resulted in a bounty that few imagined possible 20 years ago.
In 1986, Jefferson County (Birmingham) Circuit Judge Sandra Storm ordered a child, initials "R.C.," into Alabama's foster care system. In what Storm described as a "nightmarish, long journey through hospital mental wards, psychotropic medication and separation from his family," R.C. experienced a shameful maltreatment that symbolized the shortcomings of an entire system.
At that time, a governor-appointed commission discerned that the average caseload of child welfare caseworkers in Alabama was 65. There was inadequate training for caseworkers, child abuse allegations left uninvestigated, antiquated equipment for caseworkers' use, and on and on. The child welfare system was failing Alabama's most needy. The American Civil Liberties Union sued the state on behalf of R.C. at the request of his father, and the state agreed to enter into a consent decree requiring radical improvement--or "conversions"--of its child welfare system in each of the state's 67 counties.
While space does not allow for a comprehensive enumeration of what was done to transform from then to now, some cardinal principles and accomplishments merit special mention.
First, each county, under oversight of the state office, developed a system of care founded on the principles that: 1) children should live with their families when they can do so safely, 2) comprehensive services should be provided to children and their families, 3) regular family-planning meetings with the family and the individualized community support teams should be held with reunification, relative placement, or adoption as their focus, and 4) reports of child abuse and neglect should be rapidly investigated.
In addition, the state and each county developed citizen-composed quality assurance committees to review practice and outcome information related to the improvement efforts. Report cards for each county's child-welfare performance were created and permanently and publicly posted on the Department of Human Resources' web site. The report card consists of a four-level ranking of the respective county's performance over a six-month period based on the following indicators: 1) Safety -- cases of abuse/neglect, or CANS, pending, prevention assessments pending more than 90 days, and response time of initial contacts on CANs received; 2) Permanency -- no compelling reasons/termination of parental rights 15 of last 22 months, TPR petitions overdue greater than 90 days for children with adoption as the permanency plan; 3) Qualitative Items (from reviews of cases by County QA Committees) -- average child and family status rating, average system performance rating.
Employee professionalism was enhanced by a tiered social-work classification. Child-welfare caseworkers are expected to have at least a bachelor of social work degree and are required to obtain a license within one year of employment. Attracting caseworkers with a master's degree in social work and financially providing incentives to licensure were given priority in the classification changes. An extensive training curriculum was developed, accompanied by an aggressive recruitment and retention effort. A consortium of Alabama universities and colleges, which train and produce BSWs and MSWs, was initiated, allowing for improved student preparedness for DHR employment.
An effort to maximize federal funds was successful. In conjunction with a greater investment of state dollars, the effort led to a rise in the number of social workers in the field, an increase in entry pay and supplements for service in certain placements, and the reduction in worker caseloads to an average of 13.
Each county, and five separate regions in Jefferson County--Alabama's largest--then were subjected to a rigorous "conversion" process, culminating in a "conversion review" that included presentations by child welfare staff and community stakeholders to the federal monitor, plaintiffs' attorneys and DHR state leadership. These 71 presentations were conducted only after the respective system had matured and could document attainment of performance on 51 separate indicators of safety, permanency and well-being. The monitor then made a decision as to whether conversion had been achieved. Prior to the state's release, each of the 71 jurisdictions successfully "converted" and the state ultimately demonstrated that the systemic conversion could be sustained.
In a Jan. 21, 2007, op-ed piece in the Birmingham News, now retired Judge Storm reflected that R.C. is now 26 years old and that "the progress the state has accomplished improving the DHR system is nothing short of phenomenal ... there are enough people and funding to meet professional standards at DHR in every county."
Indeed, the professional practice, employee quality and support, family-centered focus, and standards of performance that are measured constantly and used to manage have transformed a system from what many national experts have concluded is a proverbial "worst-to-first" achievement.
But what now? How do we reassure some who are jittery about a regression to times past given that court oversight has been withdrawn? First, the family-focused philosophy has been and continues to be systemically imbedded throughout our agency. Basically, the mantra is "if it isn't good enough for my child, it isn't good enough for anyone else's child." We have even gone to the extent of permanently codifying all of the "R.C." policy in the DHR Administrative Code. Now, R.C. principles are DHR principles, and we are raising our performance expectations and practice above what the consent decree contemplated. Second, the aforementioned permanent Quality Assurance Committees and supervisory and performance accountability network from the counties to the state office help ensure our steadfastness.
To build some redundancy of quality review into the system, in addition to each county's ongoing review by its respective County QA Committee, the state QA office subjects every county to an exhaustive case and system review--basically replicating the original conversion review process using the 51 performance indicators--at least once every three years.
Meanwhile, we are challenging ourselves to expand our "continuums of care," where we no longer provide incentives to the provider community for services to children in out-of-home placement, but rather for aggressive work to prevent removal or rapidly reunify families by "stepping children down" on a continuum of services from more restrictive to least restrictive placement. Providers, as a result, are overhauling their models of service provision. We have expanded competition among provider partners and closely monitor performance outcomes.
Now every child in any out-of-home care placement is assessed every six months by an independent assessment team, using a standardized instrument to determine progress, and either stepping that child down and back toward home or determining why current services are not resulting in progress and making the appropriate adjustment. We are even preparing what we believe is a highly progressive proposal that providers are paid only upon a child's return to home, and we expect to have positive responses.
Our intent is to continue an annual reduction in the number of children coming into out-of-home care while expanding our in-home services. We have more than 75 percent of our children in care in the home and/or basic foster care, one-fifth of 1 percent in deep-end residential services, and 12 percent of children in out-of-state placements. Our goal in 2007 is to return all out-of-state children home and to step down those children in out-of-home care so that 75 percent have a less restrictive placement than they currently occupy.
The harvest recently reaped in Alabama's child welfare system signals the end of but one season. The good farmer knows that the new season has now begun. While we are pleased, we are not proud because the work continues with the hope of a more bountiful harvest ahead.
Page Walley is the commissioner of Alabama's Department of Human Resources.
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||Leadership and Employee Training|
|Publication:||Policy & Practice|
|Date:||Mar 1, 2007|
|Previous Article:||Workforce development must respond to change.|
|Next Article:||An update on ICPC.|