Hawaii Statewide Assessment Report

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Hawaii Statewide Assessment Report


Hawaii Statewide Assessment

April 2009

    Table of Contents

Introduction 4

Section I General Information and Overview 6

Section II Safety and Permanency Data 22

    Section III Narrative Assessment of Child and Family Outcomes 42

    A. Safety 42

    Safety Outcome 1: Children are, first and foremost, protected 42

    from abuse and neglect

    Safety Outcome 2: Children are safely maintained in their homes 54

    whenever possible and appropriate

    B. Permanency 61

    Permanency Outcome 1: Children have permanency and 61

    stability in their living situations

    Permanency Outcome 2: The continuity of family relationships 80

    and connections is preserved for children

    C. Child and Family Well-Being 104

    Well-Being Outcome 1: Families have enhanced capacity to 104

    provide for their children‘s needs

    Well-Being Outcome 2: Children receive appropriate services 116

    to meet their educational needs

    Well-Being Outcome 3: Children receive adequate services to 121

    meet their physical and mental health needs

Section IV Systemic Factors 132

    A. Statewide Information System 132

    B. Case Review System 135

    C. Quality Assurance System 151

    D. Staff and Provider Training 166

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    E. Service Array and Resource Development 180

    F. Agency Responsiveness to the Community 199

    G. Foster and Adoptive Home Licensing, Approval and Recruitment 207 Section V State assessment of Strengths and Needs 229

Statewide Assessment Checklist 238


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    In July 2003, the Hawaii Department of Human Services (DHS) joined with its Federal partner, the Administration on Children and Families (ACF) of the U.S. Department of Health and Human Services (DHHS) to review the effectiveness and quality of Child Welfare Services (CWS) in Hawaii. This joint review effort was known as the Child and Family Services Review (CFSR), Round 1. The quality and effectiveness of CWS was determined by reviewing data and practice, through on-site case reviews, in achieving 7 outcome goals:

    1. Children are first and foremost protected from abuse and neglect.

    2. Children are safely maintained in their homes whenever possible and appropriate.

    3. Children have permanency and stability in their living situations.

    4. The continuity of family relationships and connections is preserved for children.

    5. Families have enhanced capability to provide for their children‘s needs.

    6. Children receive appropriate services to meet their educational needs.

    7. Children receive adequate services to meet their physical and mental health needs.

The review criteria included:

    ; 6 data measurement ratings

    ; 23 practice ratings based on case review and observations

    ; 7 systemic factors reviewed for compliance with Federal regulations and how these systemic

    processes contribute to quality practice and outcomes

    Hawaii CWS, at that time, was found to have achieved 1 of the 7 CWS outcome goals. It was found that CWS children in Hawaii received appropriate services to meet their educational needs. CWS received Strength ratings in 2 of the 6 data measures, 4 of the 23 practice or case review ratings, and 2 of the 7 systemic factors.

The 2003 Review identified 6 key areas needing improvement in Hawaii:

    ; Timely response to reports

    ; Action must be taken to ensure that identified risks are addressed

    ; Engagement/involvement of the family and child in case planning

    ; Less re-entry into foster care

    ; More stability in foster placements

    ; More face-to-face contacts by caseworker with children, parents and foster parents

    As a result, DHS Director Lillian Koller committed Hawaii to focus on and achieving 4 CWS priorities: 1. Ensure child safety by a timely response to all reports of child abuse and neglect (CAN) accepted for

    investigation by CWS

    2. Conduct ongoing safety, risk and needs assessment on all children and families in cases active with


    3. Ensure that every family and every child, as appropriate, are actively involved in developing their case


    4. Ensure that every child in our care, every family and every foster family are visited at least once a month

    by the assigned caseworker and afforded the opportunity of a face-to-face interview in cases active with


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    Beginning July 2004, Hawaii entered into a CWS 2-Year (July 2004 through June 2006) Program Improvement Plan (PIP) agreement with ACF. Hawaii achieved all of its negotiated PIP goals except for the foster care re-entry and placement stability data goals. As a result, Hawaii avoided and scaled down an estimated $1.9 million penalty to $170,978. Hawaii was provided the opportunity to fully eliminate the remaining $170,978 penalty by achieving the data goals for foster care re-entry and placement stability by September 30, 2007. In the State Data Profile, Hawaii fell short of the data goal for placement stability for FFY 2007 but met it in the special data run for FY07b08a. Hawaii improved but did not meet the data goal for foster care re-entry. However, because of data measure changes to composites, ACF re-assessed Hawaii‘s FFY 2003 baseline data using the new composite measure and found Hawaii to have met the

    Permanency 1 composite target back then. On March 25, 2009, Hawaii was informed by ACF that Hawaii has successfully completed its PIP with no penalties applied.

    There is much to do but the guiding thinking in all plans is stretch, reach high but keep it practical, doable, and sustainable hands stretched towards the heavens, feet firmly on the ground.

    In June 2009, Hawaii DHS will again join with its Federal partner, ACF, to review how far Hawaii has come in achieving the CWS priorities for improvement from the 2003 Review and the current effectiveness and quality of CWS in Hawaii.

    This self-evaluation report, utilizing information from our own monitoring and feedback reporting systems, is prepared on the cusp of the upcoming CFSR Round 2 review to help reviewers better understand the changes that have occurred since the 2003 review and improvements made, including changes to: ; Structure, organization and delivery of CWS services; roles and responsibilities

    ; Intake, differential response decision-making tools and processes, and expansion of and creation of less

    intrusive community-based response alternatives to augment CWS response to CAN reports ; Expanded access to services, particularly substance abuse treatment and support services, mental

    health treatment and support services, including therapeutic foster homes, counseling, Enhanced

    Healthy Start services (home visiting support with substance abuse and child development consultant

    components for moms with infants and toddlers, age zero to five

    ; Working partnerships and opportunities

    The report identifies, through the lens of DHS, the strengths of the Hawaii CWS system, the system improvement needs, and the challenges we face during these tough and uncertain economic and fiscal times.

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    Section I General Information and Overview

    The Hawaii Department of Human Services (DHS) is the State agency responsible for six major State functions:

    ; Provide employment-related services, childcare services and economic assistance to eligible families

    and individuals

    ; Provide medical assistance programs to eligible families and individuals

    ; Provide child welfare and adult community care services to eligible families and individuals ; Provide a continuum of prevention, rehabilitation and treatment services and programs for at risk youth ; Serve as a catalyst to provide Hawaii residents with affordable housing and shelter ; Administer programs of vocational rehabilitation, independent living rehabilitation, services for the blind,

    and disability determination.

    The Department‘s mission is “to provide timely, efficient and effective programs, services and benefits, through the day-in and day-out efforts of our committed staff, for the purpose of achieving the outcome of empowering those who are the most vulnerable in our State to expand their capacity for self-sufficiency, self-determination, independence, healthy choices, quality of life and personal dignity.”

    DHS has four divisions and three administratively attached agencies overseeing these programs, services and benefits:

    ; Benefits, Employment and Support Services Division (BESSD)

    ; MedQUEST Division (MQD)

    ; Social Services Division (SSD)

    ; Vocational Rehabilitation Division (VRD)

    ; Hawaii Public Housing Authority (HPHA)

    ; Office of Youth Services (OYS)

    ; Commission on the Status of Women

Department goals:

    ; Customers first

    ; Personal responsibility for actions

    ; Accountability for outcomes

    ; Partnerships to create opportunity

    ; Provide self-sufficiency options

    The overarching purpose, functions and goals of DHS described above provide an understanding of the governing policies that shape and direct DHS operating programs, including Child Welfare Services (CWS). Under the leadership of the DHS Director, partnerships within DHS, as well as with external partners, have created opportunities to expand and improve access to services for CWS families and children.

Child Welfare Services

    Child welfare services (CWS) are services provided by the Child Welfare Services Branch (CWSB) under SSD to children and their families when children are reported to have been abused/neglected or at risk of abuse/neglect. These services include child protection, family support/family strengthening, foster care,

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    adoption, independent living and licensing of foster family homes, group homes and child placing organizations (CPO)

    Child abuse/neglect (CAN) is often referred to as ―harm‖ and risk of CAN as ―threatened harm.‖ CAN is defined to include physical abuse, physical neglect, medical neglect, psychological abuse, psychological neglect, inadequate care and supervision, sex abuse or giving illegal drugs to a child by a family member, legal guardian or a person responsible for that child‘s care.

    While the primary responsibility for implementing Federal and State legislative mandates regarding child welfare rests with CWSB, the child welfare system is not a single entity.

    The mission of CWSB is to ensure the safety and permanency of children in their own homes or, when necessary, in out-of-home placement. When a child cannot be safely returned to the family within a reasonable timeframe, CWSB proceeds with a permanent placement for the child through adoption, legal guardianship or other long-term substitute care. CWSB has offices on Oahu, Kauai, Maui, Molokai, Lanai and Hawaii. See ATTACHMENT A for a description of how CWSB is structured/organized for delivery of services statewide.

The basic premise behind the CWS mission is built on the following understandings:

    ; The law requires parents to provide their children with a safe family home, free from child abuse/neglect


    ; The law also provides that any person who has reason to believe that a child has been or may be

    abused/neglected can immediately report to CWS or to the county police department. ; CWSB is required by law to immediately take appropriate action on all reports of CAN ; Reports can be made to centralized, statewide CWS Intake on Oahu through a toll-free reporting hotline

    on a 24-hour, 7-days-a-week basis.

    ; Not all reports require a CWS response. CWS Intake uses safety and risk assessment screening tools

    developed by the National Resource Center on Child Protective Services to determine which reports are

    to be assigned to a CWS child protective services (CPS) specialist for timely response/comprehensive

    assessment or to alternate or differential response organizations in the community for reports

    screened/assessed as low or moderate risk with no safety issues for timely response/comprehensive


    ; CWS Intake forwards all reports received to the county police department and the police determine

    whether they will conduct a criminal investigation.

    ; The county police may investigate with the CWS child protective services specialist or conduct their own

    criminal investigation.

    ; If a law enforcement officer determines that a child is unsafe in his/her own home, the law enforcement

    officer will remove the child and release the child to the temporary custody of DHS/CWSB and for foster

    care placement. Law enforcement officers are the only ones with the legal authority to remove a child

    from his/her parents. CWSB does not have this authority

    ; CWSB has 3 working days to assess the safety of the home for the child under temporary custody. If

    CWSB determines that the child‘s home is safe, the child will be returned home by the third working day.

    ; Foster custody is the legal status defined by Hawaii Revised Statutes (HRS) 587 and means that the

    child is in foster care because the family is presently not willing and/or able to provide the child with a

    safe home, even with the assistance of a case plan.

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    ; CWSB may ask the family to sign a voluntary foster custody agreement (VFCA) to allow the child to stay

    in foster care while CWSB works with the family to identify the services that are needed to make the

    family home safe for the child‘s return.

    ; The family has the right to verbally cancel or terminate the VFCA and ask for their child to be returned.

    CWSB must either return the child or seek law enforcement intervention to have the child temporarily

    remain in CWS custody, or file a temporary foster custody (TFC) petition with Family Court. A hearing

    will be scheduled within 2 working days from the date the TFC petition is filed.

    ; The primary goal of CWSB is to provide services to assist families so they can maintain a safe home for

    their children. When this is not possible, the child will be placed in foster care and CWSB will make

    every effort to place the child with relatives, kin, or family friends who are able to meet foster home

    licensing requirements as foster parents for the child.

    ; Parents will have visits with their child, unless CWSB and/or Family Court determine that visitation is not

    in the child‘s best interest. Parents can provide names of individuals who can help with transporting the

    child or supervising the visits.

    ; CWSB is committed to keeping children safe from CAN and preserving family connections and cultural

    heritage. CWSB makes every reasonable effort to place with appropriate relatives, kin or family friends

    who are able to provide the child with a safe, protective and loving home environment while CWS works

    with the family to resolve safety issues that led to the child‘s removal from the home. CWSB is

    committed to aggressively finding family and relatives, both maternal and paternal, who can help care for

    the child. CWSB believes that it is less traumatic for the child to be placed with relatives, kin or family

    friends and is committed to engaging families to identify appropriate relatives, kin or family friends who

    can meet foster home licensing requirements. To accomplish this, CWS has implemented a family

    finding initiative.

    ; Because children, especially babies, need stable and consistent care while they are in foster care,

    CWSB wants to place children with appropriate relatives right away. CWSB currently conducts a review

    of all CWS intakes involving infants/toddlers, birth 3, to make sure that early identification/contact of

    family/relatives is conducted. This initiative is the Keiki Placement Project (KPP) ; If Family Court determines, by clear and convincing evidence, that the child cannot be returned to a safe

    family home and terminates parental rights, the child shall be permanently placed in a timely manner.

    Only Family Court has the authority to terminate parental rights.

    Families, service providers, partner agencies, and advocates are informed of these basic understandings of how today‘s CWS operates to fulfill its mission in the ―Guide to Child Welfare Services.‖

CWSB has implemented a number of changes as a result of the 2003 CFSR, which found:

    ; Discrepancy between CWSB policies, regulations, procedures, and standards (i.e., the

    agency‘s expectations of how CWS is to operate on a day-to-day basis) and actual practice as

    it occurs in the field

    ; Part of that performance gap was attributable to the growth in maltreatment reports opened for

    CWS investigation and the high rate of removal of children. These portal issues were

    overwhelming CWSB capacity to effectively manage resources and respond to client needs,

    and challenging the foster care system‘s ability to provide quality care.

    ; Excessive workloads/caseloads, staff turnover, inadequate training and inadequate oversight

    of frontline performance reportedly contributed to the lack of timely response to CAN reports

    and the lack of regular monthly face-to-face contacts with children, the birth family and foster

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    family. As a result, the relationship of the caseworker with birth parents, foster parents and

    children in some situations was compromised because workers could not provide the kind of

    case work/attention needed and, in turn, could not overcome resistance and skepticism, and

    foster the mutual trust needed for successful collaboration to achieve desired outcomes for


    ; The case review made clear that some CWS workers have difficulty assessing the needs of

    families and that these assessments (when completed) do not always address the underlying

    needs of the family.

    ; It was concluded that the duties of CWS workers and supervisory priorities must be re-aligned

    to emphasize these ―must dos‖:

    1 Ensure child safety by a timely response to all reports of child abuse and neglect (CAN) accepted for

    investigation by CWS

    2 Conduct initial and ongoing safety, risk and needs assessment (comprehensive strengths and

    risks/needs assessment) on all children and families in cases active with CWS

    3 Ensure that every family and every child, as appropriate, are actively involved in developing their

    case plan

    4 Ensure that every child in our care, every family and every foster family are visited at least once a

    month by the assigned caseworker and afforded the opportunity of a face-to-face interview in cases

    active with CWS

    ; With a high rate of removal from home, the review found Hawaii‘s foster care system struggling to

    find safe and nurturing foster homes to meet a child‘s wellbeing needs; that there was a need to

    not only expand the recruitment, home study, training, licensing, match and support of suitable

    foster homes, but to do so comprehensively in conjunction with the strategy of expanded

    involvement of family, relatives, kin and family friends in kinship care.

    ; The review also found that services are not available and accessible to all children and families

    needing them at the time they need them the most to prevent removal, to reunite. The most

    critical service gaps identified were:

     Expansion/creation of services to implement an alternate/differential response system

     Access to substance abuse treatment and appropriate after-care services

     Access to mental health treatment, including therapeutic foster homes for children/youth.

Today, Hawaii is in a better position:

    ; Reports investigated is about half of what it was in FFY 2003

    Special run

    FY07b08a: 4,698

    FFY 2007: 4,643

    FFY 2003: 8,228

    ; Reports confirmed is half of what it was in FFY 2003

    Special run

    FY07b08a: 2,110

    FFY 2007: 2,075

    FFY 2003: 4,046

    ; Children removed from the home and entering foster care is down to almost half of what it was

    in FFY 2003

    Special run

    FY07b08a: 1,318

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    FFY 2007: 1,416 children entered foster care FFY 2003: 2,409

    ; There are proportionately less Hawaiian/part-Hawaiian children in foster care.

    Percent of State general child population, 0 17

    years of age, that Hawaiian and part-Hawaiian children comprise, 2007: 31.3%

    Percent of CWS foster care population, SFY 2008: 34.9% Percent of CWS foster care population, SFY 2004: 49.7%

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