COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES - - - Room 400, City Hall Philadelphia, Pennsylvania Wednesday, December 13, 2006 11:15 a.m. - - - PRESENT: COUNCILWOMAN MARIAN B. TASCO, CHAIR COUNCILWOMAN DONNA REED MILLER COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN JAMES KENNEY COUNCILMAN DARRELL L. CLARKE COUNCILWOMAN JANNIE L. BLACKWELL RESOLUTION 060867 - Resolution authorizing the Council Committee on Public Health and Human Services to hold hearings regarding Child Abuse Deaths in the City of Philadelphia. - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
Good morning. Thank you all for coming today. We're going to get started. Some of our Councilmembers just finished a hearing and will be in as we move forward. We do not want to keep you here all day, and we do appreciate and thank you for coming on time, and I'm very sensitive to people's time and don't want to have them linger longer than they have to. We'd like to have the Clerk read the resolution, please.
Resolution 060867, resolution authorizing the Council Committee on Public Health and Human Services to hold hearings regarding child abuse deaths in the City of Philadelphia.
Thank you. I just have some brief opening remarks, and as other Councilmembers come in, they may also have remarks. The death of any child in our City is one death too many, and the death of a child as a result of child abuse is 3 12/13/06 - PUBLIC HEALTH - RES. 060867 especially troubling and tragic. Today, in this context, the Committee on Public Health and Human Services is holding this hearing to analyze and discuss the issue of child abuse deaths in Philadelphia. The purpose of this hearing is to have a broad and comprehensive review of the City's child abuse death rate and discuss with the various state, local and private parties and agencies which are responsible for the welfare of our children what ideas, remedies and/or solutions that they have identified or propose to address this issue. As the City's principal oversight body, it is our duty as the City Council to investigate this issue and to take any action necessary to protect our children. From this perspective, we take our oversight role seriously, and we will always endeavor to provide our children, the children of the City of Philadelphia, with the 4 12/13/06 - PUBLIC HEALTH - RES. 060867 opportunity to grow and develop in a safe home and city. Let me recognize Councilwoman Donna Reed Miller. She doesn't have any comments right now. One of the reasons we're also holding this hearing is, at the time the news article appeared, we were to have on October 25th a briefing regarding the issue, but we did not have the opportunity to do so because of the events that took place prior to that with the resignation of the Commissioner, Cheryl Ransom-Garner. Ms. Garner was to be here this morning, but due to -- I don't want to get into her business. She couldn't come this morning, but has sent a statement, which I would like to read for the record. "Good morning, Madam Chair Councilwoman Tasco and City Council members. My name is Cheryl Ransom-Garner 5 12/13/06 - PUBLIC HEALTH - RES. 060867 and I am the former Commissioner of the Department of Human Services, DHS, for the City. I have 34 years of service in City government and years of child 7 welfare experience as social worker, 8 program analyst, contract and compliance 9 administrator, executive deputy and chief 10 of staff, deputy commissioner and 11 commissioner. 12 Mayor Street appointed me 13 Acting Commissioner of DHS in May 2004 14 and subsequently to the permanent status 15 of Commissioner in February 2006. I 16 immediately began working to engage a 17 dedicated and committed staff, as well as 18 all of the partners involved in the 19 child-serving system necessary to assist 20 with this important work, including our 21 young people and parents. 22 In addition to overseeing a 23 huge child welfare system, I worked tirelessly to plan and implement numerous reforms and initiatives necessary to move 6 12/13/06 - PUBLIC HEALTH - RES. 060867 the agency forward. A system must continue to operate as reforms are implemented, as well as focus on continuous quality improvement. During my tenure as DHS Commissioner, DHS took its responsibilities relating to child safety and protection very seriously. In fact, DHS served nearly 26,000 at-risk children in 2005, not counting the thousands of children served in after-school and youth development programs. Accordingly, I am deeply distressed by any child death, and one child death is too many. I take each death personally, as does the DHS staff. During my tenure, DHS extensively reviewed the circumstances surrounding every child death, for each such examination informs DHS training, best practice, policies, procedures and services. Because of my deep commitment to children, I was also distressed by the recent Philadelphia Inquirer reports on 7 12/13/06 - PUBLIC HEALTH - RES. 060867 child abuse deaths of children. Unfortunately, the Inquirer articles regarding this tragic situation did not accurately reflect the Department's involvement.
For example, out of the 7 cases cited in 2005, two were open and 8 receiving contracted services and DHS was 9 investigating one of the cases. 10 Further, during my tenure, DHS 11 implemented several reforms to completion 12 with other reforms in process and/or in 13 the planning stages. By way of example, 14 DHS, one, finalized search procedures to 15 better locate families utilizing a 16 private investigator; raised the standard 17 for locating and ensuring safety of children through priority responses; developed guidelines to assess reports on newborns; aggressively promoted and participated in a public awareness campaign regarding the dangers of co-sleeping due to the increasing number of deaths caused by parents sleeping with their babies and also provided cribs to 8 12/13/06 - PUBLIC HEALTH - RES. 060867 parents in need; developed the capacity to provide an immediate assessment and commencement of crisis-oriented, intensive services to support families in maintaining their children in their homes during the DHS investigation phase; adopted the practice guide for investigating child fatalities and scheduled training for staff; assisted in the development of a curriculum to implement the mandated Pennsylvania State Safety Assessment Bulletin and scheduled training for staff; adopted the structured decision-making policy to improve consistency of information collected and response decisions for Child Abuse Hotline reports; 49,988 reports of alleged abuse and neglect were investigated from 2003-2005; implemented front-end design, a continuum of diversion services consisting of community-based prevention programs designed to preserve and strengthen families in their communities; developed 9 12/13/06 - PUBLIC HEALTH - RES. 060867 an older youth initiative to better serve the growing number of teens entering the child welfare system; provided expert consultation to staff to support children and families exposed to domestic violence; greatly improved permanency rates for children with the goal of reunification. As DHS Commissioner, I did everything in my power to ensure the safety, protection and well-being of children served by DHS. The challenging work performed by DHS is mandated and regulated to achieve the ultimate goal of protecting and ensuring the safety of children, preventing abuse, neglect and delinquency in addition to making every effort to assure that children are placed with a permanent family. Many of these children come from families that are challenged by poverty, behavioral health issues, unemployment, domestic violence, lack of housing, inadequate education and 10 12/13/06 - PUBLIC HEALTH - RES. 060867 deficient job skills, to name some of the most prominent challenges. These societal ills impact families most seriously. Families, therefore, must be supported and empowered so that our communities are strengthened to support the safety and well-being of our children. This challenge not only requires a strong and dedicated DHS effort, it requires political will and the collective work of the community at large: all systems, all partners and adequate resources from public, private, business, community and faith-based entities. We start from the cradle through high school graduation and beyond. It starts with each one of us. We must insist on what we need to get the job done and not short change ourselves. We must take ownership and hold ourselves accountable. Our children are our future and deserve our very best if we expect to have better systems of care and a better 11 12/13/06 - PUBLIC HEALTH - RES. 060867 life for all children. " That is Cheryl Ransom's statement. This Committee will not adjourn at the end of today.
We will recess, and hopefully we will be able to have Cheryl come in to further expand on her role as Commissioner at DHS and allow us to ask her some questions and tell us what we would have asked her had she been here today and what she might have told us when she was here at our October 25th briefing. We believe she gave dedicated service to the Department and we want to continue to be supportive. , Interim Commissioner, Department of Human Services, and Frank Cervone, Child Welfare Review Panel. And I'd like to recognize Councilwoman Blondell Reynolds Brown. And as they come to the 12 12/13/06 - PUBLIC HEALTH - RES. 060867 table, I respectfully ask Councilwoman if she has opening statements.
Thank you, Madam Chairwoman Tasco, the members of the Committee and to our listening audience. I was listening attentively upstairs wrapping up a meeting while attempting to prepare for this one. But as Councilwoman Tasco stated in her opening statements, no 12 child in our City should move or be in a circumstance where questions are not asked and probed from this side of the table. So our interest is purely to attempt to get our arms around the why but, more importantly, to look at the systems to see how and what we need to do differently and better going forward so that at no time again in the future are we sitting at the table having a conversation about this type of circumstance. It behooves us to do all we can as professionals to -- my now broken 13 12/13/06 - PUBLIC HEALTH - RES. 060867 record message is to talk across systems, improve and close the gaps across systems, because I think that's one of the ultimate resolutions in us better serving our City's children. Thank you very much, Madam Chairperson.
Thank you very much. Dr. Evans, we thank you for coming today and we know that this is an interim sort of like assignment for you. We have a deep appreciation what you're doing at CBH and support you in that effort and want to give you all the support as you try to wade through the Department that you probably find probably challenging and something new. So we welcome you and thank you to just share us your thoughts, and you have testimony you'd like to present.
Sure. Thank you, Councilwoman Tasco. Just before I begin to read my testimony, which you have in 14 12/13/06 - PUBLIC HEALTH - RES. 060867 full, and I'll try to abbreviate as much as I can, although I think my written testimony, all of what we have written here is important to say. You said that this is a challenging position, and obviously it is, but I want to make clear that I sit here very proud to lead this organization on this interim basis. I've been very pleasantly surprised by the number of dedicated professionals, many of whom are here with me today, and I feel very hopeful for where this Department is going.
Thank you. Let me interrupt you and recognize Councilman Kenney. Thank you for coming.
Good morning, Madam Chair Councilwoman Marian Tasco and City Council members. I am Dr. Arthur C. Evans, Acting Commissioner of the Department of Human Services. First I want to thank you for the opportunity to 15 12/13/06 - PUBLIC HEALTH - RES. 060867 share with you the actions that DHS has taken in recent weeks to ensure the safety of our children. We are here today because of the tragic deaths of children involved in the child welfare system. The recent spate of stories that have appeared in the media can only be described as heartbreaking. And while Philadelphia's child death rate is among the lowest in all major urban cities in the nation, the death of even one child in our city as a result of abuse or neglect is unacceptable, even if sometimes unstoppable. Most child deaths are not due to a single correctable factor, but to a confluence of factors that are many times unpredictable and, therefore, often impossible to prevent. However, DHS is taking every possible measure to not only address the factors within families and communities that lead to abuse and neglect, but also to improve our own 16 12/13/06 - PUBLIC HEALTH - RES. 060867 policies, practices and procedures so that the likelihood of another death occurring is greatly reduced or eliminated. I want to assure you that we take the concerns that have been raised about DHS extremely seriously and we are working diligently to not only prevent another occurrence, but to ensure the safety and well-being of all children in our care. We recognize the urgent nature of this mandate, and we have taken immediate action. Over the past few weeks, DHS has developed and begun implementing an aggressive action plan, which provides the framework for our reform efforts. I'll just outline that framework quickly here. The first domain is to really look at the children in our system and ensure that they are safe. The second is to look at our own policies and practices. Thirdly, we want to and are 17 12/13/06 - PUBLIC HEALTH - RES. 060867 enhancing provider oversight and monitoring, and, fourthly, we are looking at how we are going to increase our openness, transparency and accountability. The goal of this plan is to immediately assess the service delivery gaps and strengthen internal and external controls that will lead to improved safety of children in our care. In developing this plan, we have conferred with numerous external consultants who are nationally recognized child welfare experts. Based on their recommendations, we have enhanced the way we approach child safety visits. The centerpiece of our action plan is the child safety visits that we're conducting. We are in the process of conducting face-to-face visits with every child in the system to ensure that they are safe and that we have the most effective and appropriate services in place to support them and their families. 18 12/13/06 - PUBLIC HEALTH - RES. 060867 During each of these in-home visits, DHS social workers are using a standardized tool to assess the safety and risk factors of each child living in the home, inquire about the visits from SCOH providers. In other words, we are ensuring that the SCOH providers are making those visits and looking at the quality of those visits. We're also looking at and taking necessary action to strengthen the safety response, and, finally, to provide information about DHS, the provider and the family's responsibilities. One of the things that we found is that sometimes family members are not always aware of what is available to them in terms of recourse when they feel that they're not getting the services that they need, and we feel it's important that they know how to advocate for themselves and we're providing people with that information on these visits. All of these visits will be 19 12/13/06 - PUBLIC HEALTH - RES. 060867 completed within the next three months, and the results of the visits will be shared with the newly established Child Welfare Panel and other stakeholders.
I am personally monitoring the progress of these visits through detailed reports. We have a very elaborate work group structure and steering committee to provide oversight to this process. Moreover, we are conducting quality service reviews on a sample of cases in units where child deaths have occurred in order to identify and address any problems. Quality service reviews include a case record review using a standardized instrument as well as a series of interviews with all of those individuals involved in the case, including the worker and supervisor, parents or caregivers, service providers, teachers and others. Through this process, the case is examined on key safety, well-being and permanency factors. In addition, the process helps 20 12/13/06 - PUBLIC HEALTH - RES. 060867 to identify systemic factors impacting service delivery. The reviews will be conducted by both internal and external reviewers who have been trained in the QSR process and will utilize the State's own review instrument. We are also reviewing all recommendations that resulted from the death reviews in the past five years. We're looking at what those recommendations were and we are systematically looking at the extent to which we've implemented them, and to the degree that we haven't, we will be implementing those things that we can implement quickly on a short time frame. Because so many of our services are provided by community-based organizations, we are assessing and revising the way we provide monitoring and oversight to contract agencies. We are working with the Center for the Support of Families to improve our methodology for monitoring SCOH providers 21 12/13/06 - PUBLIC HEALTH - RES. 060867 and will be conducting reviews of all SCOH providers. Any provider that had child deaths in their caseload during 2004 to 2006 will undergo a special in-depth review and will be evaluated first. Evaluations will consider agency performance data from a broad range of sources, including the Program Evaluation Unit, Quality Service Review, the Family Assessment Form and the CAPE Investigation Unit. We're also augmenting the way we monitor other DHS provider services using data from a variety of other sources. Recognizing and appreciating the public's concern about the City's child welfare system, the Department is proactively working to hold ourselves accountable and to be open and transparent in ways it has not historically been. For example, we are creating a website to keep the public apprised of our progress in making reforms. We have made ourselves 22 12/13/06 - PUBLIC HEALTH - RES. 060867 available to the press and have responded to a variety of questions raised through the press -- raised to the Department through the press. In addition, we are adding staff to our Ombudsman Office so we can adequately address the concerns of families that are involved with the Department. It should be noted that the current law does not allow us to freely discuss the specifics of individual cases. Therefore, we support state laws that would allow greater transparency and openness in disclosing information regarding cases of serious child abuse and neglect. We strongly believe that these steps will strengthen our reform efforts as well as our service system. Understanding the value of collaboration and inclusion in this process, we have zealously involved stakeholders in our reform efforts. We are reconstituting the Child Welfare Advisory Board to monitor progress toward 23 12/13/06 - PUBLIC HEALTH - RES. 060867 the goals of the action plan and to provide ongoing feedback on DHS operations and services. The Advisory Board has parent -- or will have parent, foster parent, youth, advocate, academic and provider participation.
We are also meeting regularly with a variety of child welfare experts and advocates, providers, academics from respected schools of social work, the Department of Public Health, the union and even in the press in order to gather information and vet our plans and ideas. In addition, we are instituting a suggestion box so our front-line workers can share their firsthand knowledge and expertise and suggest improvements to our current system. Through our collaboration with all of these external entities, DHS is inviting and encouraging another level of departmental review and scrutiny that will help to assure that we remain focused and on track. Moreover, we have 24 12/13/06 - PUBLIC HEALTH - RES. 060867 provided an opportunity for the broader community to work with us hand in hand as we strive to improve our service delivery system. I just want to also at this point just say that we have gotten as a department tremendous support from a variety of people, including the union, which has been tremendous in helping us to respond to this crisis. Secretary Richman has been extremely helpful. Our child advocate community has been enormously supportive. Academic institution, our provider community has really stepped up and has, even without our nudging, done a variety of things that we think will greatly enhance the safety and services that are being delivered. And so I just wanted to make sure that that was acknowledged, and I think that goes a long way in helping the Department to respond to this current crisis. As I've noted in all these 25 12/13/06 - PUBLIC HEALTH - RES. 060867 matters, we have acted with urgency and with an unwavering focus on addressing the immediate concerns. We anticipate that the Mayor's Child Welfare Panel will concentrate on long-term policy and practice issues, and we eagerly await their findings and recommendations. However, we know that the children in our care depend on us to keep them safe and we cannot afford to wait for the Panel's conclusions to begin correcting problems. We've identified issues that need our immediate attention and we are aggressively working on them. I can assure you that we are working closely and coordinating our efforts with the Child Welfare Panel and ensuring that our efforts are complimentary. Beyond the work that we are doing to protect children, DHS has remained committed to providing a continuum of preventive care for children and families. We know that abuse, neglect and delinquency are often 12/13/06 - PUBLIC HEALTH - RES. 060867 symptoms of hopelessness and despair that all too many Philadelphia families face. Therefore, we are dedicated to helping families access the social supports that will allow them to thrive. Through our Prevention Division, we offer a comprehensive network of support services to help families address underlying problems that lead to abuse and neglect before their situation results in more intensive involvement in the child welfare system. These services include, but are not limited to, diversion case management, parenting support and education, kinship care, crisis nurseries, enhanced services for compromised caregivers, as well as an array of positive youth development and truancy and delinquency prevention programs. We offer these services in neighborhoods throughout the City. What's more, these services are provided by community-based agencies that are 27 12/13/06 - PUBLIC HEALTH - RES. 060867 known and trusted by the members of the communities they serve. And these providers ensure that their services are truly accessible by making them available in a variety of venues, including community-based one-stop shopping sites, neighborhood schools and community centers. We even support numerous home visiting programs. I want to emphasize that while acknowledging that serious mistakes may have been made, our staff is exceedingly competent and dedicated to excellence in the service to our children and families.
In fact, within the past two years, the Department has been nationally recognized for numerous groundbreaking programs that are the result of hard work and the vision of our staff and its leadership. For example, the Achieving Reunification Center, a one-stop center specifically designed to assist families in overcoming the barriers to reunification, which opened in March 28 12/13/06 - PUBLIC HEALTH - RES. 060867 2005, is the first of its kind and has become a national model for reunification. The ARC provides a host of on-site services, including workforce development, counseling support and parent education, housing and financial counseling, fatherhood support and technology-based learning, even professional clothing for clients who are interviewing or starting employment. Likewise, the Achieving Independence Center, a one-stop service center which helps youth aging out of foster care successfully transition into adulthood, is unique to Philadelphia. The AIC provides services including housing, employment, mentoring, educational assistance and life skills training to approximately 1,500 foster youth. Furthermore, Philadelphia's progressive board extension policy has enabled more youth to complete school and, therefore, achieve better life outcomes. 29 12/13/06 - PUBLIC HEALTH - RES. 060867 DHS has also received national recognition for its efforts to reduce overcrowding in the Youth Study Center. In collaboration with Family Court and other key stakeholders, we have steadily decreased the average daily population of the center, reduced the average length of stay for youth, and consistently moved youth to treatment sites when they are adjudicated. These efforts were highlighted in a 2003 report published by the National Center for Juvenile Justice, the major research organization analyzing juvenile justice data nationwide, and again in 2005 in a MacArthur Foundation report called Keystones for Reform. Performance-based contracting, another innovative practice that has received national attention, has resulted in a reduction in the number of dependent children by nearly 15 percent from 2003 to 2005. DHS has also been extremely successful in achieving timely permanency 30 12/13/06 - PUBLIC HEALTH - RES. 060867 for youth in our care. Through the Achieving Reunification Center, we are working with parents who have children in placement to ensure that they have access to the supports they need to meet their reunification goals and reunite their families. In cases where reunification is not appropriate or possible, we have moved quickly to achieve other permanency options such as adoption or permanent legal custodianship. Through inspired efforts such as the Philadelphia Heart Gallery and Wednesday's Child, we are raising awareness of the need for loving adoptive families. I want to thank Councilwoman Blondell Reynolds Brown for her leadership in that area and her consistent support. In fact, in 2005, the percent of children in foster care who achieved permanency was up 85 percent from 2002. Furthermore, the biological and adoptive families are better prepared to provide a 31 12/13/06 - PUBLIC HEALTH - RES. 060867 stable home life for their children as demonstrated by the fact that in 2005, the number of youth who returned to the child welfare system decreased by 33 percent. These tremendous accomplishments are the result of the hard work of the staff of DHS and its many providers. It is imperative that we develop strategies to boost staff morale and promote hope. These individuals have dedicated their lives to child welfare and will continue to work with us as we strive to improve and enhance our service delivery system. They deserve our confidence and they need our support. The Department of Human Services is at a unique moment in time.
While the recent media reports about the child welfare system in Philadelphia have been sobering, they also present us with an opportunity to create a system that is on the cutting edge of what child welfare delivery should look like. Moreover, we 32 12/13/06 - PUBLIC HEALTH - RES. 060867 have the commitment of a broad array of people and institutions eager to partner with us to ensure that we succeed. One other important stakeholder that has been very supportive is the court system, Family Court and Judge Kevin Dougherty, who I failed to mention earlier. In conclusion, I want to reiterate that the protection of Philadelphia's most vulnerable children from abuse and neglect is the Department's highest priority. We are fervently dedicated to correcting the problems both within the agency and its contract service provider network in order to guarantee that all of the children in our care are safe and well. And we will continue to work tirelessly to provide the highest quality services so that children and families can flourish. I thank you for your time.
Thank you 33 12/13/06 - PUBLIC HEALTH - RES. 060867 very much. We appreciate your testimony. We usually ask the panel to testify, but Councilwoman Miller has to go to her office for a moment for a meeting and would like to ask you a question, and then we'll have the other two witnesses present their testimony.
Probably when I was 13 years old I decided I wanted to be a social worker, and the reason that I wanted to be a social worker was because one of my best friends was a foster child, and I felt like I needed to grow up and protect children like her. As it turns out, everything turned out fine, but it wasn't until she was removed from that particular home that life got better for her. And me and all my friends were very protective of her, and, actually, what we actually did was talk her into running away, and I hid 34 12/13/06 - PUBLIC HEALTH - RES. 060867 her in my house for about a week, and her parents finally came. We just figured they were afraid because they knew we were going to tell the social worker all the things that she wouldn't tell her. And when she was removed from that home and sent to another very loving home, we were all very happy. And I've seen how that impacts her today as an adult and how she treats her children. So I say all that to say that I've always been concerned about children and about people, and, of course, the articles in the paper disturbed everyone. I just have a question, and since you said that you're doing quality review and the family assessment, whatever, I can't remember the acronyms, but you have them in here --
-- I was wondering, the 17-year-old girl that was home with her mother and she died, I 35 12/13/06 - PUBLIC HEALTH - RES. 060867 don't know the name. I don't remember the name, but I'm sure you know the incident. She was disabled. I think she had cerebral palsy. Is there a special visitation schedule for children that really can't communicate when you're talking about quality review and how people are being treated? Is that something that you have or is that something you're considering?
Well, that's a very good question. I think it's at the heart of the kinds of things that we're looking at right now. When families have what are called services in their own home or SCOH -- you may have heard the term "SCOH" --
-- services, our social workers -- they have a social worker who is assigned by the provider agency who is providing services, and that social worker may see the family 36 12/13/06 - PUBLIC HEALTH - RES. 060867 anywhere from one to three times at least minimally or more, depending on the case. In addition to that, our social workers will visit the family at least once a quarter. One of the things that we're looking at is, is that an adequate schedule? Should we be seeing the families more frequently? We're also looking at what is it that we're asking during those visits. One of the unintended benefits or unexpected benefits, I think, out of this is, as we consult with national experts and with our own staff about what we should be looking at on these safety visits, we developed a standardized tool, and the feedback that we're getting from the staff is that they really appreciate that tool, and I think there will be a lot of support for us using that in an ongoing way. It gives them structure and allows us to actually collect some very important and useful data. 37 12/13/06 - PUBLIC HEALTH - RES. 060867 So I think all of those are things that we're currently looking at. We'll probably make some decisions around some of these fairly quickly, but we also anticipate that the Child Welfare Panel will be looking at that issue and making some recommendations as well.
Because I wondered if you had a special unit that was particularly trained just to work with disabled children, those families.
That's a very good question. One of the, I guess, debates in the field, certainly within the Department, is the degree to which you specialize and the degree to which everyone should have a certain set of skills. So one school of thought is that everyone should be able to see the whole range of families that we see at the extreme. The other view is that we should have specialized units, specialized providers. And in reality, we do have that now. We have providers 38 12/13/06 - PUBLIC HEALTH - RES. 060867 who specialize in seeing certain kinds of families. And so another issue that we're going to be looking at is the degree to which we should have special units for really difficult and challenging medical cases. Again, we do have that to some degree now. One of the things we want to look at is do we need to expand that. I should also say that one of the things we're moving very quickly on is contracting with a group that will provide specialized nursing consultation to our staff. What we're finding is that many of the families have ongoing chronic medical conditions, and we feel that our staff need more support around that, and so that's a contract that we hope to have in place within the next month or so.
I have a daughter that died of cancer, and after her death, one of your employees or one of the employees at DHS tried to recruit me to be a foster parent for a medically 39 12/13/06 - PUBLIC HEALTH - RES. 060867 needy, I'll say, or for a child that had medical issues, and she said, With all that you've been through, you'd be an excellent foster mother, but, actually, somebody like me at that time, there's no 7 way I could have done it, but I understood what she was attempting to do. I think that people that work for DHS -- and I do have friends that work there, too -- are very dedicated and committed, but I just think we all have to work together to improve whatever we need to improve. And in the situation with the 17-year-old, then it sounds to me that the SCOH worker should have been the one there. Because I just can't figure out how someone missed that that was happening in that house. It's hard for me to figure that out.
Again, we clearly know that we not only need to look at the schedule, but we as a department need to have mechanisms to ensure that the schedule that the providers should be 40 12/13/06 - PUBLIC HEALTH - RES. 060867 adhering to is actually adhered to. One of the, again, benefits of the safety visits that we're doing is that we're not only looking at the safety and well-being of children, but we're also looking at the extent to which the providers are making the visits, the quality of those visits, whether those visits are useful. And as I said, to the degree that we institutionalize this through the standardized tool, those will be questions that we ask in an ongoing basis. So we will greatly reduce, I believe, the probability that the kind of thing that we may have seen in that case would happen again.
Thank you, Madam Chair. Doctor, in reviewing some of the information that was provided by 41 12/13/06 - PUBLIC HEALTH - RES. 060867 Councilwoman Tasco's staff in preparation for the hearing, I came across a chart that shows a great disparity between some major urban areas like Chicago, Los Angeles and New York on the number of children that are taken from their parents, which ranges from Cook County, Chicago being 6.2, New York 10.9 and Los Angeles County 13.9 children per thousand. I think it's per thousand. Every thousand impoverished children. And we're at 40.4. Could you enlighten us as to why the disparity, in your view?
Well, I don't know all the history behind that, as you can appreciate. It's something that the Department has had on its radar for a while. I think the Department is making and has made a lot of progress in this area of reducing the number of children that are placed out of the home. And, in fact, if you look -- I have data that we can share with you that shows that over 42 12/13/06 - PUBLIC HEALTH - RES. 060867 the last several years, those numbers have been coming down and they continue to come down. Even with the stories that have appeared in the media, if you look at the number of children who are currently placed in our system today, it's less than what it was at the beginning of the year. So I think that the Department has made a lot of progress in that area. We continue to look at that. Perhaps other people who have some of the history of working in the Department can speak more to that. What I can tell you is that we are aggressively looking at that issue.
And hopefully future testimony will clear -- not clear it up, but at least give some explanation. From your employees' standpoint -- I mean, this is a very, very difficult job that can wear a person down, dishearten them, stress them. And 43 12/13/06 - PUBLIC HEALTH - RES. 060867 really they see, I guess, along with police officers and firefighters, probably some of the more tragic situations in our City. Do we have any type of training program or relief program or psychology program for our own employees who battle with this every day? I mean, after a while, if you spend 15, 20, years -- 11 (Applause.) 12
-- you have 13 to see a lot of stuff that -- I mean, do 14 we do retreats? Do we do break times? 15 Do we allow people certain time off away 16 from this stuff? I mean, I know the 17 caseload is tremendous, but I can't 18 imagine that you could go through this 19 day after day and not either become cold 20 to it or just become beaten down by it. 21
I think it's an 22 excellent question, and as a 23 psychologist, I'm a little more sensitive 24 to this than perhaps other administrators 25 might be. I'm very concerned about the 44 12/13/06 - PUBLIC HEALTH - RES. 060867 stress level. I think ordinarily it's a stressful job. I think it's particularly stressful right now. One of the things that we've done is to begin talking about it as an issue that we have to take on as an organization. A number of people have volunteered to help us with this issue, and I'm going to be looking at that as we go into the new year. I understand that the union may also have counseling that's available to people, and we want to encourage people to do that. But I think the heart of your question is that we have to have an organizational response to the issue of chronic stress. It's fine that individuals can go and get counseling, that's great, but organizationally we have to create an environment where people feel supported, which I think the people generally do, but people also have a way of expressing that stress and supervisors have a way of helping people 45 12/13/06 - PUBLIC HEALTH - RES. 060867 to manage that.
Absolutely. Well, I think that in the first part of next year, it's something that I think is important for us to look at, and as I said, we've already begun to talk about that, and we want to look at concretely what kinds of things we can put into place.
I think it's an important discussion to have within the framework of your budget request, because if there's additional money that's needed to do that kind of, I guess, mental relief work for your own employees. I can't imagine having to deal with these issues like this every day. Not only the number of people on your caseload, but the tragic circumstances of almost every one of these kids have to really just beat you 46 12/13/06 - PUBLIC HEALTH - RES. 060867 down after a while.
It's enormously stressful, and that's why I think that we as leadership and certainly other people in government have to, I think, make statements of support to the staff, because, frankly, I don't think that they've always felt that way, and so I've gone out of my way to make sure that they understand that our leadership supports them, finds value in what they're doing. And I think to the degree that other people in government make those statements, I think it's very important to the staff.
Thank you. I just want to piggyback on that, too. I think it's very important that individuals who do work with problems and circumstances like this to have break time. Sometimes you just have to like go away for a day or two just to kind of like have down time. I mean, we 47 12/13/06 - PUBLIC HEALTH - RES. 060867 don't deal nearly to the level that these workers deal in your department, but we deal with constituent services every day. I mean, the phone rings constantly. So when I can, I give my staff down time. Look, let's just take this day off or, you know, you need to get a break. So as you look at this, think about that, too, so that the worker may not have to take a sick day off, but they have that down time that they can take and not feel guilty about being out. So it's very important, I think.
I am absolutely compelled to comment on the same point. I, quite frankly, didn't last as a social worker after seven months because of the complex issues that these young ladies were facing at Slayton Farm School, and the fact of the matter 48 12/13/06 - PUBLIC HEALTH - RES. 060867 is that teachers get a break and lawyers are required to get additional credits which has to be done over X number of days, physicians for sure. So it really could be and should be a part of the professional development that comes with any profession; in particular, for social workers, who, like me, simply could not separate my own emotion from the circumstance of the young ladies I was working with. So I completely support Councilman Kenney's recommendation that you factor this in as a budget item. The time is now. The reality is real. (Applause.)
And the opportunity is here, for reasons that have brought us to the table. Thank you very much.
We're going to go to Frank Cervone, let him make his testimony and come back. We have lots of questions. 49 12/13/06 - PUBLIC HEALTH - RES. 060867
Good morning, Madam Chair and members of Council. I am Frank Cervone and I appear today on behalf of --
I'm sorry about mispronouncing your name. I've always done it wrong.
That's okay. I know you love us. I appear today on behalf of the Child Welfare Review Panel for the purpose of bringing you up to date on the creation of the Panel and on our work. The Panel's Co-Chair, Dr. Carol Wilson Spigner, would have liked to have been here herself, but a conflict in her teaching schedule prevented her from appearing today. She welcomes the opportunity to address Council on the work of the Panel at a later date. On a daily basis, I serve as Executive Director of the Support Center for Child Advocates. Child Advocates is Philadelphia's pro bono lawyer program 50 12/13/06 - PUBLIC HEALTH - RES. 060867 for abuse and neglected children. We offer the skills and dedication of lawyer-social worker teams, representing children in court proceedings and working with them and their families. For almost 30 years, we have served as a resource to this community and to this Council, and I thank you for the opportunity to serve in this role once again. By Executive Order on November 2, 2006, Mayor Street created the Child Welfare Review Panel to assist the City in fulfilling its mission of protecting the safety of its children and to provide certain direction to the Department of Human Services in the performance of its work. The Panel was fully named by announcement of the Mayor on November 24, 2006. The members of the Panel are as follows: Dr. Carol Wilson Spigner, Co-Chair of the Panel and a professor at the University of Pennsylvania's School of Social Policy and Practice; Mr. Bill 51 12/13/06 - PUBLIC HEALTH - RES. 060867 Mills, Co-Chair of the Panel and President of PNC Bank for Pennsylvania and New Jersey; myself; Mr. Marc Cherna, the Director of Human Services for Allegheny County, Pennsylvania; Dr. Cindy Christian, Chair of Child Abuse and Neglect Prevention at the Children's Hospital of Philadelphia and Associate Professor of Pediatrics at the University of Pennsylvania School of Medicine; Dr. David Sanders, Executive Vice-President for Systems Improvement at Casey Family Programs in Seattle, Washington and former Director of the Los Angeles County Department of Children's Services; Linda Spears, social worker and Vice-President for Corporate Communications and Development at the Child Welfare League of America in Washington, DC; Carol Tracy, attorney and Executive Director of the Women's Law Project here in Philadelphia; and Dr. Fred Wulczyn, the Research Fellow at the Chapin Hall Center for Children at 52 12/13/06 - PUBLIC HEALTH - RES. 060867 the University of Chicago. Each of these Panel members is serving with dedication to this community and its children and families, and without compensation. With due exception for this speaker, the Panel members bring to the work an extraordinary range of professional expertise, experience and skills. Their credentials are impressive, and our City is most fortunate to have their service. The panel members have met with the Mayor, who reaffirmed his commitment to our independence and our authority to access all information that the members believe they may need. We are to be driven solely by consideration of the safety and well-being of Philadelphia's children. The Mayor reiterated the vision of the Executive Order that the Review Panel's deliberations, findings and recommendations should be open and transparent to the full extent allowed by law. 53 12/13/06 - PUBLIC HEALTH - RES. 060867 We are clear about our role: to engage in a comprehensive review process, assisting the City by ensuring the immediate safety of all children in its care, by reviewing all child deaths in the last five years and recommending reforms in DHS policies and procedures. We will conduct a systemic case record review of abuse and neglect fatalities in Philadelphia since the beginning of 2002 to identify areas for corrective action and to improve outcomes for children.
We expect to examine policies and patterns of conduct and practice among caseworkers, contractors, social workers and administrators. We expect to make recommendations to improve decision-making, training, quality assurance, contract and case management, the provision of direct services, case documentation, the supervision of employees and administrative oversight. It is our expectation that the Panel's recommendations will set the stage for 54 12/13/06 - PUBLIC HEALTH - RES. 060867 reform of the child welfare system in Philadelphia. The Panel members recognize that meeting the needs of abused and neglected children presents the most urgent mandate and requires the provision of the most complex set of services faced by the human services system. Issues range from teen parenthood, homelessness, substance abuse, mental health problems, and sexual and physical abuse and neglect. Many families face multiple problems that require extensive coordination with other parts of the human service, education, healthcare and court systems. Wherever one finds it, child welfare work is not easy. Over the last three weeks, the Panel members have been hard at work in learning about the Philadelphia child welfare system, studying data, identifying needed information and reviewing the fatality review summaries. We had our first working meeting last 55 12/13/06 - PUBLIC HEALTH - RES. 060867 week, and we have plans to meet regularly for the next five months. The Mayor has asked for our report in May 2007. Input from the community is essential to our work. The Panel will receive information from the community and its stakeholders in a variety of ways. We will soon have a website available on the Internet to receive information and for posting of meeting minutes and other information. Members of the public at large will be able to provide information, and we will honor their request for confidentiality. We will convene meetings in the community to elicit the wisdom and experience of the consumers and partners of DHS. The Panel will consult with a body of stakeholders who have special knowledge of the agency and its work. We will be accessible to the media and the public at large as we move forward. The Panel welcomes the opportunity to again appear before Council during this input process. After 56 12/13/06 - PUBLIC HEALTH - RES. 060867 the Panel's recommendations are submitted, the City Council's participation will be important in assuring that the needed reforms are accomplished. In conclusion, I know that I speak for my colleague members of the Panel in expressing our shared dedication to protecting the children of the City of Philadelphia. Thank you.
Dr. Joseph Kuna is my Deputy. He's just here to help me. I don't think he has prepared -- he was sitting here sweating when you said that.
Well, he may have to answer some questions. 57 12/13/06 - PUBLIC HEALTH - RES. 060867 I guess that you weren't there, and that's the disadvantage of not having the former Commissioner here, but when the story hit the paper, do you know what the genesis of this story was?
I don't, and since I was outside the Department, I don't know all of the history and all of what went into that. I simply know what I read in the newspapers.
No. I'm sorry. I really don't have any information about the genesis of the story either myself.
Of the cases that were reported, the 17 deaths, how many were closed? Do you have that information? I guess how many were open?
In the former Commissioner Ransom-Garner's testimony, two were open, one was under investigation. So I believe the remainder of them were not open and 58 12/13/06 - PUBLIC HEALTH - RES. 060867 active at the time of the story.
Well, what is DHS's responsibility to families that cases have been with you but then have been closed?
Generally when a case is closed, if there's an ongoing need for services that doesn't require DHS involvement, there's a referral to a community-based service of our own extensive prevention network and there's also ongoing involvement with other systems like CBH, but the feeling is that the family has demonstrated their ability to engage in those systems and work with them on their own without having DHS involved. If a child is returned from foster care, on the other hand, we will provide a year of what's called after-care support through provider agencies to the family for those 12 months. But typically if the case is closed, it's because there's a sense that 59 12/13/06 - PUBLIC HEALTH - RES. 060867 the family can engage with community supports on their own without DHS's further involvement there.
So the 6 cases were closed, were not under your 7 jurisdiction. In the process of closing 8 those cases, how do you determine that 9 you close the case and what support is 10 given to the worker and supervision given 11 to the worker as he or she begins to 12 close the case out? 13
In the situation of 14 services to children in their own homes, there is a closing risk assessment. The provider agency provides the closing FATH (ph). The previous quarterly reports to the provider are reviewed, and generally by requirement, the supervisor and worker review those documents and make a decision as to whether or not they believe the case continues to need services or can be closed. So there's a series of documents that should be reviewed and 60 12/13/06 - PUBLIC HEALTH - RES. 060867 there's a conversation. And typically the supervisors know these cases fairly well, so they're pretty much aware of what issues brought the family to our attention, what the progress has been as the case is reviewed every six months and has some sense as to whether or not the level of risk in the situation warrants our ability to close the case.
Now, Mr. Cervone, your panel, what will you review in order to get a handle on what happened? Will you go back and review these cases, and in what period will you review those cases, time period, before you begin to recommend changes in procedures?
Square in our sights are five years of child fatalities. The Department by law and regulation is required to identify a child who died who had been in their care for a period of time prior to that death, of course, and to study, essentially 61 12/13/06 - PUBLIC HEALTH - RES. 060867 study, what they did and what their contract agents did in the case. The Department then issues a set of recommendations, essentially a report. We have already received those reports. They are several hundred pages in number, and we will -- we expect within the next several weeks to begin reviewing the actual case record on each family, which you might imagine might be an historical document of great length in paper and years. We will look at the practice decisions that were made through the course of the case, why it opened, what services went in and why, were they delivered, were they delivered well, why it ended, why a case was closed, as you suggested, what went into the decision to close the case. We expect this to be as comprehensive an examination as one might humanly conduct. In fact, it's a rather large task, but this is the vision that really we were imparted by the Mayor's 62 12/13/06 - PUBLIC HEALTH - RES. 060867 Executive Order and that has been the character of the conversation to date among the Panel.
Well, in conjunction with that, Dr. Evans, you outlined in your testimony a number of innovative programs or procedures that you've begun to put in place. How did you come to make those changes without having the full review of the cases that were closed?
We believe that there's certain things that we cannot afford to wait on, and one of the things that we're doing -- I talk regularly with one of the Co-Chairs, Dr. Carol Spigner, regularly throughout the week to make sure that we are coordinating our efforts. And I think the way we've divided the world is that we're going to be, as a department, very focused on operations and looking at things that we can do immediately to ensure ourselves that we're using the best practices. 63 12/13/06 - PUBLIC HEALTH - RES. 060867 The Panel is going to take a broader look. They're going to, first of all, do a more in-depth look at the death reviews or fatality reviews that have been done, but also look at the broader policy and more long-term policy issues. What we're going to have to do, as we've already done, is to continue to talk very regularly to make sure that there's not overlap or that we are getting in each other's way. Our approach to the fatality reviews is really focused on what were the recommendations that happened. We're not spending our energy and time at this point trying to look at and trying to understand what happened in a particular case. The Child Welfare Panel will do that. What we want to do is to look at all of those reports that have been done, what were the recommendations. We've already started to do this. We've taken those, we've summarized what the recommendations are. And then we're 64 12/13/06 - PUBLIC HEALTH - RES. 060867 going to go back and systematically look at all of those recommendations that have been made and which ones have been implemented, and to the degree that they haven't been implemented and there are things that we can move on quickly, we want to start to move on those.
Are these the recommendations that were reported in the paper that were made by your consultant?
No. Each time there is a child death, there is a fairly elaborate review process that is done, which includes taking information from the Medical Examiner and lots of other places. And out of that process, at the end of each one of those child death reviews, there is a set of recommendations. And so what we want to do is to go back and look at all the recommendations, see what things there are there and then, again, implement those that we think we can implement 65 12/13/06 - PUBLIC HEALTH - RES. 060867 quickly.
You know, some of those cases -- I can't remember them all that were cited. I read when you first talked about it, you don't want any child to be abused, and none of us do, but how do we prevent that? How do we prevent someone who decides to get up this morning and beat their child?
I don't know that we can prevent that 100 percent. Unless we're going to put police in people's houses, there's no way that we can do that. What we can do is because there's a fairly good body of research that tells us the correlates of abuse or cases where there is likely to be abuse, I think we have to do a better job of using that body of knowledge to make decisions about how we work with those cases, what decisions that we make. And so by doing that -- and then making sure that we have policies and practices in place to ensure that those procedures are adhered to, I 66 12/13/06 - PUBLIC HEALTH - RES. 060867 think we'd greatly reduce the probability that those kinds of things can happen. But we can't guarantee. It would be disingenuous if we tried to guarantee that.
Some of the policies and procedures that you outline, how many have been implemented since you've been there and how many were in place before you got there?
Well, one of the things I tried to do in my testimony is to acknowledge that lots of good things have been happening in the Department, many good things that were already in place and that some of the things that we're going to be doing are going to be building on or completing those. There are a number of things that I outlined in my testimony that are things that we, as some of these more recent cases have come to light, have decided to go back and take a look at and look at whether we can do some things 67 12/13/06 - PUBLIC HEALTH - RES. 060867 differently. So there are a number of things. The structured safety visit tool that I described is one example of that. We're doing a number of things around how we monitor and provide oversight to the providers. I think that that's one of the areas where we have a lot that we can do that I think will greatly enhance what we're doing there. We're looking at not only how we evaluate -- and we are going back and evaluating every SCOH provider. Those are the providers that we've been talking about. But we're also looking at how do we set up systems that capture all of the information that we have on a provider. One of the things that came to light as we started to look at some of these cases is that some people in the Department would have a little bit of information, other people might have another bit of information, but all of that information wasn't coming together. So, for example, the social worker who 68 12/13/06 - PUBLIC HEALTH - RES. 060867 was going out might note something that may not cause alarm, the CAPE Unit, which does the evaluations, may have noted something that may not have caused alarm, but taken together, those things may rise to the point where we might want to take some action. And so a major part of the monitoring process is not to do a lot of new things, but to try to tie information that is currently available together and for us to use and analyze that information and make good decisions.
To your Deputy, would you identify yourself, please, sir, for the record?
Certainly. My name is Joseph Kuna. I'm the Acting Deputy Commissioner at DHS, K-U-N-A.
Let me ask you a question. Was there any formal review of DHS's performance and progress before or after the Inquirer article?
Well, we certainly went through a state licensure review 69 12/13/06 - PUBLIC HEALTH - RES. 060867 prior to the article. Immediately after the article, within days, Dr. Evans' action plan was put in place. So that would be the current review of our practices and procedures that we're engaged in right now. The typical ongoing review of contract agencies as part of CAPE's work was happening. So there was what we had in place operational at the time the story broke, and there's been some enhancements of those since Dr. Evans arrived. But that's typically what we were doing at the moment that the story appeared in the Inquirer.
Dr. Evans, if you implement new procedures, what budget implications would they have? Do you have enough money to implement all the procedures that you would like or what might be needed over there? And also, do you have enough staff to follow through on all the recommendations that you have or recommendations that might 70 12/13/06 - PUBLIC HEALTH - RES. 060867 come back from this Panel?
I'll answer the first question first, which is the budget implications. We're actually looking at that. I meet with the Budget Director on a fairly regular basis. One of the things we're looking at is the specific action plan items and what their costs would be ongoing, but part of the additional costs will be in terms of -- particularly if we expand the amount of time that social workers are expected to be involved in some of these cases, that's not at this point quantifiable. We will have a much better sense of that after we complete the safety visits. What it looks like right now is that we're able to do this within the current budget, but as I said, we will have to look at and make some assessment after the completion of the safety visits and any policy changes that we make, what implications that will have ongoing. In terms of staffing, that's 71 12/13/06 - PUBLIC HEALTH - RES. 060867 another area that we need to look at. One of the things that the Department has been doing over the last several years, probably, I don't know, going back five years is my understanding, is adding to its needs-based budget dollars that allow the Department to reduce the staff-to-client ratio. That number has been coming down steadily over the last five years.
Now it's about -- overall it's about 16.48, but if you look at the bulk of the social workers who are case carrying, it's a little under 20. It's 19.77 to one. Those ratios have continued to come down. We would like to see them come down even more. One of the things we'll be looking at and talking to the State about is the degree which we can speed that process up of reducing case ratios. 72 12/13/06 - PUBLIC HEALTH - RES. 060867
One of the questions I wrote down here when you were talking about -- I can't remember. I didn't write the page down. What mental health services -- I guess how does a caseworker get support for a family for mental health services if they notice that there may be some problem there and they might need to have mental health intervention? How do you come to give that social worker support?
I'm going to let Dr. Kuna answer that, but one comment that I want to make -- and obviously given my role as the City's Behavioral Health Director, I look at many of these cases with a somewhat different eye in understanding the impact the mental health issues are having, and I would go as far to say that a fairly high proportion of the families that we serve have some kind of cognitive impairment. So it's either mental retardation, substance abuse or mental health 73 12/13/06 - PUBLIC HEALTH - RES. 060867 problems. And I think one of the benefits of sitting in both places right now is that we really have an opportunity to take the collaboration that the departments have been doing over the last several years to another level, and we've already begun to discuss that, but I want to Dr. Kuna to talk about what the actual practice is.
Currently at DHS we have six CBH care managers and a supervisor embedded with our staff who are there every day -- some are in Intake; the remainder are in the Central Referral Unit -- whose business it is to review the children who are going into placement in terms of their behavioral health services and needs and to be available to consult with other staff as calls come in on the hotline or as problems arise in caseloads with regard to the services that are being delivered or mental health problems that the workers may be encountering. 74 12/13/06 - PUBLIC HEALTH - RES. 060867 We also have a Small Clinical Management Unit that works in the Behavioral Health Center made up of three psychologists, one of whom specializes in issues of sexual perpetration in cases, one around sexual abuse victims and the third around mental retardation and cognitive issues for parents and children. They're also available to assist staff in securing assessments, helping determine what kind of assessments people need and in interpreting the information that comes back from assessors for them so they understand how to make application for them in their program. Essentially, CBH care managers on site with us are kind of a clinical management arm, and there's also a large CBH contingent and family court who works with the Family Court and DHS staff over there as behavioral health issues are identified in court hearings, and they're able to make referrals and to consult 75 12/13/06 - PUBLIC HEALTH - RES. 060867 with the judges and staff right in the Family Court building.
If there's a family with a parent with substance abuse and maybe mental health problems but the caseworker feels that the child may be okay, does the CBH still remain in touch with that family? As you move to close that case, is that case closed with still the parent having maybe some substance abuse problems or mental health problems, but the child appears to be -- to the caseworker, the family seems to be okay? Because sometimes with substance abuse, they're clean for a minute and then the next they're back. How do you deal with that? Because the caseworker says, Well, the mother is fine, she's been in rehab, she seems to be doing okay and we're going to close this case. I mean, the caseworker has to figure out how. But then because of the substance abuse issue, the mother may injure the child or abuse the child, but the case is 76 12/13/06 - PUBLIC HEALTH - RES. 060867 closed from DHS. But when something happens to the child, DHS is blamed for what happened to the child.
Well, I'm sure that every DHS employee in this room right now understands completely what you're suggesting, because every time we close a case and we feel comfortable that the risk is manageable or low enough for us to do that, we're relying on our partners in the systems to continue with substance abuse treatment or behavioral health treatment or whatever the service is that we would hope is in place with them. At some point, we have to make the decision that the family can manage to be connected to those services and rely on them to reengage us if parents drop out of treatment and if they seem to have reached a point that they're putting their children back at risk. We're talking about managing thousands and thousands of families, so we're very reliant on all of the other systems, 77 12/13/06 - PUBLIC HEALTH - RES. 060867 including the school system, to keep us appraised of the fact that once we're not involved in a family any longer and if our prevention services are not involved with the family, that they are doing the good job of keeping an eye on safety for children. Many of them are mandated reporters and they should be reengaging DHS if they feel that the family is sliding down a slope again where the kids are at risk because someone has relapsed or not taking their medication or no 15 longer involved. A number of these behavioral health families also have intensive case managers involved with them, so there's an opportunity through the care managers at CBH for us to be re-alerted if something is going on. But we are totally dependent on those outside systems to keep us appraised of what's happening once DHS is no longer engaged with the family. 78 12/13/06 - PUBLIC HEALTH - RES. 060867
Mr. Cervone, when you all look at these cases, will you look at the entire family picture and sort of evaluate -- well, it's not evaluate, but to see just where the family was with all of these issues that might be involved with that family? Can you look at 17, cases, or however 10 many cases there were back to 2003 or 11 2005 -- 12
-- 50 or 14 more cases and you look at all the cases 15 that DHS manages, you see -- and I'm not 16 saying that 50 aren't important, they are 17 important, but looking at them in 18 relationship to 29,000 or 30,000 cases 19 that they deal with a year, what might 20 have happened in those situations that didn't happen in all the other cases?
Yeah. Two thoughts come to mind. I think our business really considers a wholistic approach to be the right way to go and so 79 12/13/06 - PUBLIC HEALTH - RES. 060867 it makes sense to look at the whole family, to look at them in the context of their situation, do they have disabilities, are there poverty issues, maybe multiple generations of abuse. We have, as you might imagine, people who are not in our business are shocked to learn that there are 34-year-old grandmothers in the world. There are lots of those in our business. You can imagine all of the tremendous implications that occur when 14-year-olds have kids and then when they grow up and their 14-year-olds have kids. So we definitely want to think across generations and to think in a wholistic way. Second, certainly in my own reflections on the cases that I've looked at just since we've been provided with the reviews, we will likely see in those case studies issues that though they precede the fatality are in some ways larger than, because they're more 80 12/13/06 - PUBLIC HEALTH - RES. 060867 recurrent than the fatality. And I don't mean in any way, of course, to minimize a death, but rather to note that the frequency by which we engage in X or Y practice is going to have implications to a much larger degree numerically, a decision to close a case based on some particular strand of information, for instance. Well, you can imagine thankfully many, many right decisions are made in that way. When we found a kind of wrong decision made that way, we should expect that most of those kids are not going to die and yet that decision was still wrong. That is to say, in this cohort of 50 kids and 50 families, I expect we're going to find all sorts of good work and lots of problems that will be generalizable to the larger population. When we put that individual case data together with trend analysis, such as Councilman Kenney suggested earlier, as you'll hear about later from some of the other presenters, I expect 81 12/13/06 - PUBLIC HEALTH - RES. 060867 that we're going to find some compelling lessons to learn about how the Department is doing business, both in its good and bad. It should be noted, I don't think I've heard yet today -- well, actually, Dr. Evans spoke to the tremendous investment in prevention dollars. The Philadelphia system invests more dollars in child abuse and placement prevention than most jurisdictions in the country. We're a leader in the dollars that we spend in prevention. I think still to be learned is whether we're spending those dollars wisely, whether we're evaluating and guiding well the provision of those services, and, of course, for the future, whether you and other political bodies will continue to appropriate those dollars. But we're a model program just in terms of the dollars focused on prevention.
I just have a couple more questions and then 82 12/13/06 - PUBLIC HEALTH - RES. 060867 I'll be done and ask Councilwoman Brown to ask questions. Mr. Cervone, how is the DHS staff involved in the work of the Panel? What is required from DHS workers and how does it impact on their schedule to provide services to their clients?
We're still devising our own work plan. We have a big meeting next week in which we expect to finalize the Panel's work plan, and we'll have a better sense of what supportive work and interactive work we'll need from the Department. To date, it has been an administrative role. Dr. Evans and his staff have been providing us reams of information. This is a very complex business, which means it's an information-intensive kind of business. We haven't yet decided how we're going to go about the case reading per se where actually members of the Panel interview workers maybe, but the actual methodology 83 12/13/06 - PUBLIC HEALTH - RES. 060867 of that interaction, I think, has yet to be seen. I know that the several other studies and investigations, both the internal and external that the Department is engaging, I've certainly heard colloquially from folks in the system is a tremendous burden on day-to-day practice, and we're aware of that. This is a group of, as I related to you their credentials and experience, this is a panel of folks with experience in running systems and they don't want the work to stop.
My last question to both of you, Dr. Evans and to Mr. Cervone, you both talked about transparency, and we read that in the paper about the request for transparency. What does that mean? What are you asking the State to be transparent?
Let me begin about the law reform issue. The law is rather clear that identifying information 84 12/13/06 - PUBLIC HEALTH - RES. 060867 about children and families who are involved with a child welfare agency, identifying information may not be released. It's actually a crime to release this information. And that is both, in a sense, the right path and for some types of information perhaps overbroad. It's right because families need privacy. It's right because this work is -- the work of healing is hard. On the way there, you want to encourage people to come to the table for healing work. In the child death cases, there are the surviving children, who will undoubtedly be victimized in some level by attention. This is why child welfare work is often done, in a sense, in a quiet behind-the-scenes manner. At the same time, quiet work often becomes secret work, and secret work often becomes secret problems. And this is a department that has, throughout my career, tended towards a kind of 85 12/13/06 - PUBLIC HEALTH - RES. 060867 insularity that has been troublesome. The Mayor recognized that, I think, from the outset and made it a part of his order that we should move to become a transparent agency and that our process should itself be available, accessible, to the community. So that's what the law reform is going to be about. What we will struggle with, I think, in the next several weeks -- we are honestly struggling with it now -- is how to allow people to come forward who might not be apt to come forward in the light of the public eye for folks who have concerns about the practice of the agency, about the direction of the program, about even how their colleagues are behaving. We need to make a safe place so that they can come forward. And that's just difficult. This is the most public of settings, but you can appreciate that without a subpoena power, you wouldn't get some people to say some things. And 86 12/13/06 - PUBLIC HEALTH - RES. 060867 we don't have subpoena power. I'm not sure we need it, but we need to create a safe place for folks to be able to come forward to tell us what they think they need us to know.
Well, who makes the determination of what can be public and what can't be? I mean, are there various agencies? What does the State say?
Well, the Panel has been given independence by the Mayor, and so I think it's fair to say that we will set the rules for our own deliberations. Certainly the Mayor may have some comment, in a sense, on the plan, what we're thinking of as the communications plan. Who sets the rules about access to information in general is the State Legislature. We're talking about largely state law and state regulation. The federal government provides some direction in certain areas of privacy, 87 12/13/06 - PUBLIC HEALTH - RES. 060867 like HIV information, drug treatment information, certain education information. These are bodies of law that come from the feds. But in the main, child welfare information and the regulations pertaining to its release or access are governed by state law and then by the regulations promulgated by the Department of Public Welfare and its Secretary.
I think "appeal" would be the wrong word, but we certainly, I expect, will make recommendations, and then we'll leave it up to Dr. Evans and to you to make the appeal and, of course, the rest of this community.
I think the issue of transparency is really critical for the Department, and I think as Frank alluded to, when you don't have transparency or when we're prevented 88 12/13/06 - PUBLIC HEALTH - RES. 060867 really by law to disclose certain kinds of information, it creates the sense of secrecy, and whether we did something wrong or not, in the public's mind, we did because we can't talk about it. And that's problematic for us, and I think the Administration -- I know I've heard the Mayor say this, that he'd like to give up a lot of this information so that people can see what's happened in these cases. And in my testimony I state that we'd like to see the laws change so that we can disclose more information so that there is no ambiguity or concern that the Department is hiding something. So that's a constraint that we have to currently work under. I think we're working around that relative to the specific cases. On the other hand, there is a lot of information that we can give people and we're doing a lot of things to do that. Probably the part of our action plan that has the largest number of tasks associated with it is this idea of 89 12/13/06 - PUBLIC HEALTH - RES. 060867 openness and transparency. We've made a commitment to create a website so that people can track our progress. When we released the action plan, we invited Mr. Cervone and advocates, we invited the union, we invited other stakeholders, providers and we invited the media. And we talked about the plan, and, frankly, they critiqued the plan in front of the media. I think that that's healthy. When we did the action plan, we reached out to a number of people, including Judge Dougherty and the courts, to the Chairs of the social work schools in town, to providers. Everyone in this town who has anything to do with child welfare has looked at this plan at this point probably and have critiqued the plan. But I think that that is the thing that makes the plan -- gives it strength, because I think that there is consensus that we're looking at the right things. I think it gives our stakeholders and the 90 12/13/06 - PUBLIC HEALTH - RES. 060867 public confidence that we're doing the right thing, and we're very committed to that. Just a couple of other things that we're doing. In addition to the website where we will track our progress on implementing various reforms, we are reinstituting our Child Advisory Board, because I think it's important for us to hear in an organized way from various stakeholders, and one of the enhancements that we think is really important to that is the addition of parents and youth to that Board. We need to be able to hear them directly. We need to empower people to be able to give us that kind of feedback, and then we need to be able to do something with it. But there are a lot of ways that we're doing that, and I think it will make the Department better. I think it will make the Department stronger and, more importantly, it will begin to reinstitute the trust of the public of 91 12/13/06 - PUBLIC HEALTH - RES. 060867 the Department.
Yes. Thank you, Madam Chairwoman. Councilwoman Tasco's question and your very eloquent response, Mr. Cervone, is a segue to a very similar question I had with regards to the state law revision. So what I'm hearing, in short, is that you support a revision in the current state law in spite of the very fragile line that exists between confidentiality and the need to know in our effort to save children? Is that what I'm hearing?
Well, I certainly speak -- the devil will be in the details, as you might imagine. Many states have gone this way. So that in the instance of child death, for instance, both the State of New Jersey and Rhode Island, State of Rhode Island, now publish the fatality reviews on a 92 12/13/06 - PUBLIC HEALTH - RES. 060867 website out of an office, a statewide office, of the child advocate. It's essentially for the purpose of publication.
Was transparency a factor in the case that has brought us to this table?
Well, remember, there are many cases. In answer to your genesis question earlier, the genesis, from my perspective, is that the child -- that children died who may or may not have been known and served by the Department, and the rest of the community didn't get to know that. And it really, from my perspective, was the public service on the part of the newspaper folks to bring this to the light of day. Colleagues of mine may differ with me about that. But you have to imagine that transparency or the lack thereof is a problem at every level. Workers who can't get to know everything -- these 93 12/13/06 - PUBLIC HEALTH - RES. 060867 aren't purposeful opaqueness but often just the complications of the work, of a multi-systemic complex system working with a family over time. A worker who goes to the door of a house isn't given today all of the information that government has available to it and isn't given that information for a variety of reasons, technology reasons, time constraints, the exigency of the moment, privacy concerns and the like. We'll get to know more of what problems there may have been with particular providers. This has certainly been the subject of public concern as covered by the press. If you look at Sunday's paper, it didn't look like a very transparent picture that brought that one particular agency to the work. I think we're going to find opaqueness -- as I said before, insularity breeds problems in this work.
There's been mentioned a number of times about 94 12/13/06 - PUBLIC HEALTH - RES. 060867 linking systems. Yesterday in the hearing chaired by Councilwoman Jannie Blackwell, there was a discovery -- it was with the Philadelphia public school system, Mr. Vallas and his team of professionals, and a question was posed on how and if the School District is connected with DHS. The discovery we learned was that the School District is not a part of the DSS Cares and so to Mr. -- forgive me, sir. In the middle?
Yes. You mentioned that there's still a reliance on systems, particularly the public School District. How does that happen then if the public school system is not indeed connected?
Well, the school system is connected to DHS by technology, in that we can access information about a child's current enrollment, their truancies, their grades and if they're in special education. We actually can 95 12/13/06 - PUBLIC HEALTH - RES. 060867 access their database and produce a report that gives us information on a particular child. But beyond that, we have no integrated data system sharing with them, and I believe you're correct, that they're not part of DSS Cares either, so that it would have to be a request by an individual worker to that system now to get information on a particular child. And it's very limited, but it is in fact much more than we had, say, three years ago. So that's in fact where we've gotten to this point with that.
Well, I would agree with you there's been an improvement, because three years ago in hearings, it was real clear that there was no connect across a number of systems. So there has been improvement, and that needs to be acknowledged as well. On of your testimony, you mention a number of practices. Are 96 12/13/06 - PUBLIC HEALTH - RES. 060867 these practices new, Dr. Evans, as a result of the new Task Force or were these practices in place prior to? I could not figure it out.
I think you're referring to the safety visit and what we're doing there?
These practices I wouldn't say are new, but the major difference is that we have standardized them and we've given the workers a tool that they can use so they are consistent in doing that. From everything that we've talked about internally, too many of our practices may be dependent on how well people -- the experience of an individual.
Versus having a tool that people can use to make sure that all of the bases are covered each time these things are done.
Is there a 97 12/13/06 - PUBLIC HEALTH - RES. 060867 standardized tool for the assessment, evaluation, the "look at" your providers?
That is. As a part of the tool that workers are using, we have a set of questions that's asked specifically about the provider: Did they show up, what kind of visit was it, how long was it, when was the last time you visited, do you feel that you're getting the services that you need, et cetera, and we are --
Yes, that is a new tool. And we are doing that and we're collecting data, so we'll be able to run reports and share those with you. So we'll be able to tell you how many of the families, for example, believe that their SCOH services are helpful.
So recognizing then that that is a new tool -- and let me just put this in context. It's always the less than one 98 12/13/06 - PUBLIC HEALTH - RES. 060867 percent either provider or professional who brings us to an unfortunate circumstance and then, of course, that situation is like a laser beam, and so the good work that the 99 percent have been doing is seldom ever recognized. In those cases of less than one percent, that needs to be dealt with. We need to be candid and honest as managers now in recognizing that there's a problem, we need to fix it, what are we going to do about it. So in the case of providers who did not meet the standards, what is the, for lack of a better word as a former manager, reprimand?
So in the one case that's been highly publicized, we terminated the contract fairly quickly, and that process had started when it was discovered the case that Councilwoman Tasco was referring to. There are various steps that we 99 12/13/06 - PUBLIC HEALTH - RES. 060867 can take leading up to closing of intake so that people get no more cases all the way up through terminating the contract. And the Department has done that historically. We continue to do that. Since I've been in the Department, we've closed intakes on at least three providers. So we're taking that very seriously. And as you say, the vast majority of our providers I feel very good about. I think they're good providers, but in those instances where providers are either unable or unwilling, we're going to act very swiftly in addressing that.
In the cases of the death of a little one, does that qualify for an immediate termination of the contract or is there a process that has to be followed before that contract is terminated?
Can I get a point of information? The provider that the young 100 12/13/06 - PUBLIC HEALTH - RES. 060867 lady with cerebral palsy died, was that contract in the process before you went to DHS? Hadn't that contract been terminated and their cases being reassigned prior to you going there?
The contract had not been terminated. The process for terminating the contract had started.
Right. So I just want that as a point of information.
Remember as well, children die for a wide variety of reasons often that have no culpable aspect to them. Children die, and kids in this cohort die because of severe illness, birth defects and the like, and 101 12/13/06 - PUBLIC HEALTH - RES. 060867 so we want to think with, in a sense, that nuance.
But if I can add, if we have a child death and it seems to be related to some issue with regard to delivery of services, DHS, I would say, uniformly closes intake immediately. We send our CAPE Unit out to conduct an investigation.
There's a unit that does investigations around complaints and then there's the Contract and Program Evaluation Unit that works in contracts that does typical annual reviews.
But they will be dispatched to review the agency's work. It may be a fairly elaborate review. It may be something simple. And then if it appears a plan of correction will address the issues, that's required of the provider, with the timetable for completion, and then they'll go out and reevaluate then. And then if they seemed to have addressed whatever the issue is, we would reopen intake. If they don't meet their plan of correction or if they seem incapable of meeting the plan of correction, then we would move through the process with Law to terminate the contract and begin the removal of the children to another provider.
But there's a process of attempts to correct, and if that doesn't work, then we move aggressively to end the service.
Mr. Cervone, you provided the name of a 103 12/13/06 - PUBLIC HEALTH - RES. 060867 list of professionals on the Task Force. Instinctively I always look at the mix and the composition. Does this list of professionals include any African-American men?
Linda Spears is an African-American woman. Bill Mills. Oh, of course, and the Co-Chair, Mr. Mills is an African-American man as well.
Underrepresented group. 104 12/13/06 - PUBLIC HEALTH - RES. 060867
I believe it is. What the Mayor did to ensure that there was broader representation is to also create a resource advisory panel or board, which will have even broader representation. And I know that there are a number of people that there was a desire to have on the panel, but you have certain number of seats for that, and so that's another way that, a formal way, that a broader set of stakeholders can be involved in the Panel.
Councilwoman Tasco covered the issue of budget. I just want to make sure I've checked off all of my questions here. To the issue of contractors, once you contract with -- they're called SCOH providers, correct?
Where does 105 12/13/06 - PUBLIC HEALTH - RES. 060867 the weight fall in terms of accountability for service to that child?
Ultimately it is with us. And one of the things that will come out both in our work in looking at this process and I think the work of the Panel is, are people clear about what their roles and responsibilities are in this arrangement. We really have a bifurcated system where you have providers who are responsible for providing the ongoing care and the Department responsible for monitoring the case and ensuring that what needs to happen happens. I think -- and this is very cursory and probably premature, but I think that we need to look at and make sure that people are clear about what that means in practice so that things don't drop through the cracks.
Okay. Then, finally, again around the issue of accountability and providers, if my memory serves me correctly, there was a 106 12/13/06 - PUBLIC HEALTH - RES. 060867 point when the notion to contract out was not embraced, if you will, by departmental employees. Now with the benefit of hindsight, is that a practice that works? Is that still the way to go in the wake of budget constraints as well as service delivery?
Well, that's a question that I feel at this point in my tenure I'm not in a position to answer. I think it's one of the things that we need to look at, and I certainly hope and I believe it's one of the things that the Panel will look at, but I do think that having clarity around what the provider has to do if we continue this relationship and what we need to do is very important. There are different schools of thoughts. There are some systems that contract out all of their services and the whole ball of wax is -- the responsibility and the actual service provision is with private providers, and 107 12/13/06 - PUBLIC HEALTH - RES. 060867 there are some systems where it's just the opposite. I came from a system in Connecticut where those services weren't contracted out and indeed the child welfare worker had complete responsibility and provided all the services. And there are the things in the middle like the system that we have here.
I think it would be a mistake historically to consider the program of, let's use the word, privatization to be a recent phenomenon. In fact, Pennsylvania is one of a number of states that have a 100-year-plus history of the private provision of social service as distinct from the Connecticut model. Massachusetts, New York, State of Virginia, Commonwealth of Virginia, Pennsylvania have these age-old organizations. The religious organizations, I think, were largely in the providers of human service work, the 108 12/13/06 - PUBLIC HEALTH - RES. 060867 care of delinquent children, the care of dependent mothers. The private provision of social service started more than 100 years ago in Chicago with Jane Hull. So I don't think the fight should be about that decision, but rather about the division of task, about accountability, as you suggested earlier, about resources; that is, financial resources, skill level, training, about communication in a complex world dealing with complex services and an array of resources. On a complex medical case, as you mentioned earlier, Councilwoman -- we do a lot of special medical cases. If we were to convene -- we often convene all the providers working with a kid. Sometimes we have to do that in a small auditorium. You'll have 30 or 40 human beings on the team. If Children's Hospital is involved with one of these complex cases, they're going to bring ten disciplines to the table just by 109 12/13/06 - PUBLIC HEALTH - RES. 060867 themselves. That's the nature, really the burden, of the work. This system couldn't do the work without the specialized care that that community brings. So I would expect that's not going to be the fight. We have a wonderful relationship, and as Dr. Evans suggested earlier, there's a great constellation of outstanding providers. It would appear from first blush there were some bad apples and that there were also some breakdown of communication that we need to upgrade how we're doing some of the work.
Okay. My final question goes to another question raised by Councilwoman Tasco, the difficulty that comes in closing a case. Once you make that decision, is there something such as an after-care unit where that case stays on a radar screen for X number of reasons, though under another definition it's officially 110 12/13/06 - PUBLIC HEALTH - RES. 060867 closed?
It happens in two instances at DHS, and they're small in relationship to all the cases we close. In one, it affects the cases that have children returned to their parents from foster care. For months, there is an 9 after-care plan, and providers can 10 provide additional services and monitor 11 that situation. And in a very tiny 12 program where we have cognitively impaired parents, it's called Scan Pad. Scan is the agency that works with those parents. The case is closed officially within DHS. It's returned to the Behavioral Health and Wellness Center for them to monitor that, but it can remain open with Scan for any number of years as long as those parents demonstrate a need for assistance in keeping their kids safe and well. It's really been designed to hopefully remove from the child welfare system parents whose cognitive 111 12/13/06 - PUBLIC HEALTH - RES. 060867 disabilities will not improve over time, but shouldn't be penalized by having their children removed and their rights terminated. It's a very small program. I would personally love to see it grow significantly, and I hope it can, but it's one of the few of that kind in the child welfare systems in the country. But it's very tiny.
Well, thank you all very much for your testimony. Madam Chair.
Just one second. Reform always comes -- that's the word of the day -- after a crisis, and certainly your panel will make recommendations, and as you work on a day-to-day basis in observing the operation of the Department, you will make recommendations, and your panel will 112 12/13/06 - PUBLIC HEALTH - RES. 060867 end at some point and you will go back to CBH and a new Commissioner will come on. What would be put in place to have ongoing review and evaluation of the system and to have reform or just responses to issues on an ongoing basis rather than react to a crisis that's precipitated maybe by a news story?
Without committing to whoever my successor will be, I think that a lot of the things that we're doing now are things that ought to stay in place, and as I said, we've gotten really good feedback from a number of them, but I think that the Child Welfare Advisory Board will be one group that will provide a certain level of both scrutiny but also advice and support. I think that the kinds of forums that we've created -- and I don't know how formal they can be or how formal they should be -- where we've brought people in, various stakeholders in, to review our plans and ideas and get their feedback before we implement them 113 12/13/06 - PUBLIC HEALTH - RES. 060867 are things that should continue. We've met at least twice since I've been on board with all of the SCOH providers in forums trying to keep them apprised. I think that all of those are things that should stay in place, and I would certainly encourage whoever takes the reins of DHS to continue those. And I also hope that one of the things that the Panel will recommend is a structure for some kind of ongoing community-based advisory group that will have broad stakeholder input. The last thing that I would say is that the Ombudsman position -- we didn't talk much about that. The Department currently has an Ombudsman's position, but it's embedded within the Department, and I think that that position has been very helpful in addressing issues or concerns that parents or other people raise about services within the DHS system. But not many people know about it, and so we're 114 12/13/06 - PUBLIC HEALTH - RES. 060867 trying to get the word out. We're probably understaffed, so we are hiring another person to go in that office, but I think -- and I haven't talked to anybody about this, but I really think that that's a position that should be outside of the Department. That position reports to the Commissioner, and as such, I think that that position can only do so much. So I hope that one of the things that the Panel will take up is this idea of having an independent body or person or office outside of the Department where people can take their issues and complaints and have that entity be able to work through those issues and have some teeth, frankly.
Thank you very much. I think that I just want to ask you one last question. When you went to the Department, you found some good things at the Department. It wasn't all bad, as portrayed in the paper. 115 12/13/06 - PUBLIC HEALTH - RES. 060867
And I didn't believe that to begin with. I have to say, Cheryl Ransom-Garner is a dear friend of mine and I have a tremendous amount of respect for her, and I've been watching the Department through her over the last couple of years and so I know that there are lots of very dedicated -- people really have dedicated their lives to doing this work. So I wasn't surprised by that. I was disappointed that that aspect of the Department hadn't been highlighted in some of the things that we saw in the media until relatively recently. And that's the part that I think I'm disappointed hasn't come out as much, all of the great work that does happen.
And I think some of the reforms that were reported in the paper, the Department had implemented a number of those reforms. I think the story might have been a little skewed, because I do believe she's done a 116 12/13/06 - PUBLIC HEALTH - RES. 060867 good job. And certainly there's always improvement in anything and we welcome improvement and recommendations for improvement, but sometimes don't throw the baby out with the bath. Thank you very much. (Applause.)
Thank you. We have another panel. We have Ms. Nancy Hardy, Deputy Secretary of the Department of Welfare -- Office of Children, Youth and Families, Pennsylvania Department of Public Welfare. Good afternoon and thank you for being so patient.
Whenever we do these hearings, they do take a long time.
But we appreciate you coming down from Harrisburg, I believe.
And we ask you to identify yourself for the record and proceed with your testimony.
As the guests leave, would you please respect the witness.
Thank you. First of all, I was going to acknowledge the other members of the Council, but they seem to have gotten up.
They're around. A lot of them leave and listen on TV.
Well, then I will acknowledge them in case they're listening on television. And I'd really like to thank you for allowing the Pennsylvania Department of Public Welfare to testify today on this most important issue. My name is Nancy Hardy and I am the Deputy Secretary of the Department of Public Welfare's Office of Children, 118 12/13/06 - PUBLIC HEALTH - RES. 060867 Youth and Families. I am here today to speak on behalf of the Secretary of the Pennsylvania Department of Public Welfare, Ms. Estelle Richman.
My testimony today will provide a brief overview of the DPW responsibilities for oversight of child welfare agencies, county agency responsibilities in providing child welfare services, and in the tragedy of a child death, the steps to be taken by DPW, the counties and the community at large. Before I describe DPW's roles and responsibilities in the Philadelphia child welfare system in more detail, I would like to say that hearings like this are a critical part of the process to ensure that the system does not fail the most vulnerable children in Philadelphia. The death of Danieal Kelly was a tragedy and it was our collective responsibility to make sure that it never happens again. 119 12/13/06 - PUBLIC HEALTH - RES. 060867 I believe we can use the unfortunate circumstances that have occurred as an opportunity to improve what we do to protect children and support families. Based on mistakes that we made, DPW has identified areas for improvement in our policies and procedures that will provide better services to children and families. As the Deputy Secretary, I am committed to working in partnership with DHS and the other child-serving systems to provide a high quality of care to the vulnerable population of children who reside in Philadelphia. DPW is responsible for assuring that public child welfare services are both available and provided by county agencies. Pennsylvania's child welfare services are state-supervised and county-administered. This means that child welfare services are organized, managed and delivered by county staff in county child welfare agencies. 120 12/13/06 - PUBLIC HEALTH - RES. 060867 DPW provides supervision and technical assistance to each county child welfare agency and establishes and enforces policy and regulation that supports the achievement of child welfare goals. DPW regulates child welfare agencies that provide partial-day or out-of-home care services, such as child residential facilities, foster care and adoption agencies. DPW is responsible for investigating reports of suspected child abuse in programs operated by the county or when the provider contracts with the county. DPW is also responsible for investigating complaints that have occurred in provider settings, such as incidents that do not rise to the level of child abuse or concerns about regulatory compliance. In addition, DPW operates a statewide child abuse hotline known as ChildLine and a statewide child abuse 121 12/13/06 - PUBLIC HEALTH - RES. 060867 history clearance registry. Every year, DPW provides a report to the Governor and the Pennsylvania General Assembly on the incidence of child abuse in the Commonwealth. The report details child abuse information and statistics for the prior calendar year. The issuance of the annual report is required under the Child Protective Services Law. And I actually had brought with me 30 of them and I left them on the train. So if there is anybody who would like a copy of that, just give me your name and I will be glad to supply it. The annual report provides information on efforts to protect and help children who were reported as victims of child abuse and neglect. Sadly, some of the children featured in the annual report are children who have died as a result of abuse or neglect. In April 2006, DPW released its most recent report on child abuse and 122 12/13/06 - PUBLIC HEALTH - RES. 060867 here is some of the key data for 2005.
Ms. Hardy, I hate to ask you this. Can I interrupt your testimony for a moment?
I have a gentleman here from Washington who has a train in a half hour. Could we ask him to come forth and then bring you back?
Sure. No problem. Matter of fact, he can even sit up here with me. I won't be by myself. And he can go.
No. Why don't you just move over and let him make his testimony and then we'll come back to you. Because we notice you have an extensive testimony.
I do, but I talk fast. That's the good news. 123 12/13/06 - PUBLIC HEALTH - RES. 060867
All right. We don't want to have him -- and we know Harrisburg is just as far as Washington. Thank you very much. Identify yourself for the record and proceed.
Sure. Thank you. Madam Chairwoman, members of the Committee, I am honored to have the opportunity to testify today. My name is Richard Wexler and I am Executive Director of the National Coalition for Child Protection Reform. Because time is short, I will omit the usual boilerplate about what a wonderful organization we are. That's in my written statement.
Thank you, and we'll make that part of the record. It will be part of the record.
My message can be summed up in six words: Stop the panic; open the doors. Philadelphia must end permanently the foster care panic that swept through the City in the wake of 124 12/13/06 - PUBLIC HEALTH - RES. 060867 newspaper revelations, and Philadelphia must begin a new era of transparency in child welfare. Two months ago, Philadelphia's child welfare system had very serious problems. Certainly it was better than it was ten years ago, but much work remained to be done. Today, all of Philadelphia's vulnerable children are less safe than they were two months ago, and unless the foster care panic is stopped and stays stopped, a year from now children will be less safe than they are today. Children are less safe because when a newspaper asked legitimate questions about the horrifying deaths of children previously known to the Department of Human Services, officials stonewalled instead of coming clean with clear, candid answers. Children are less safe because the newspaper has ignored some of the answers it has gotten in the weeks since. 125 12/13/06 - PUBLIC HEALTH - RES. 060867 Children are less safe because of a structure of state law that may require and, at a minimum, strongly encourages stonewalling. Children are less safe because when a Mayor most needed to show courage and leadership, he offered instead what can best be described as the Red Queen School of Management. And children are less safe because when a Secretary of the State Department of Public Welfare needed to show leadership to help repair the system in her state's largest city, she ran for cover. Most of all, children are less safe because all of these other mistakes set off a foster care panic, a huge sudden upsurge in the number of children taken from their parents. Not only did that hurt the children needlessly removed, it also made it even more likely that more children in real danger would be overlooked. A foster care panic leaves in its wake only chaos and despair. It must be stopped now 126 12/13/06 - PUBLIC HEALTH - RES. 060867 permanently. There are reports that the panic has in fact stopped and removals are back to where they were before. If so, that is a great credit to the leadership of Acting Commissioner Evans and the restraint of DHS's dedicated caseworkers. I should note that I found out too recently that this panic may have ended for that to be reflected in my long written presentation. I do want to state that for the record now. The bad news is that in Philadelphia, back to where they were before is still a far higher rate of removal than several other big cities. So huge problems remain. How can taking away more children put them in danger? After all, gut instinct says the children whose cases made the front page died because caseworkers did not take them from dangerous homes. So if we just take far 127 12/13/06 - PUBLIC HEALTH - RES. 060867 more children far more easily, then children will be safer. But if you really want to fix a child welfare system, you have to listen to your gut instinct and do the opposite. Every city has cases in which children die even after their plight is known to the system, and in some of those cases in every city, the decision to leave the child in the home seems inexplicable. These are the cases in which you open up the case file and find more red flags than at a Soviet mayday parade. But the reason for that is almost always because a caseworker who is often underprepared and undertrained and, most of all, desperately overwhelmed didn't have the time to evaluate the case properly. She may have had time for no 21 more than what's been called drive-by casework. What happens after the death of a child known to the system is added to the mix. Every worker becomes terrified 128 12/13/06 - PUBLIC HEALTH - RES. 060867 that her case will be the next one on the front page. If the head of the agency is forced to resign immediately, the message is reinforced.
If I don't adopt a "take the child and run" approach to the job, I'll be the next to go. So huge numbers of additional children are taken. But that only overwhelms workers even more. So they make more snap judgments and so more dreadful mistakes in both directions. Even as they take more children from homes that are safe or could be made safe with the right kinds of help, they overlook other children in real danger. So more of those children die. There have been foster care panics in three of the very few places large enough to detect patterns from fatality numbers: Illinois, New York City and Florida. In all three cases, the panics were followed by increases in child abuse fatalities. Illinois and New York City 129 12/13/06 - PUBLIC HEALTH - RES. 060867 learned from their mistakes. Thanks in part to class-action lawsuits, they reversed course and embraced safe, proven programs to keep families together. Under the leadership of David Sanders, Los Angeles County did the same. As a result, as was noted earlier, Los Angeles County takes children at about one-third the rate of Philadelphia. New York City takes children at about one-fourth the rate of Philadelphia, and in metropolitan Chicago, children are taken at less than one-sixth the rate of Philadelphia. Now, those numbers are from before the panic. Philadelphia was taking an absurd number of children before. Now, it is true that that number is, as Commissioner Evans said, a little lower than it was a couple of years ago, and that is certainly encouraging. Even more encouraging, the reduction in recent years has come with no compromise of safety. So, again, it's 130 12/13/06 - PUBLIC HEALTH - RES. 060867 a myth that child removal equals child safety. But how do we know those other cities I mentioned are right in taking fewer children and Philadelphia is wrong? After all, deaths of children known to the system have been much in the news in New York City and Illinois. Although it's important to note that many of the deaths highlighted in Illinois news coverage took place before the system reformed, and deaths of children known to the system actually have declined a little bit in New York City. Here's how we know: When it comes to child abuse fatalities, the only acceptable goal is zero. But we must seek that goal knowing that our reach always will exceed our grasp and that no 21 system ever will prevent every such tragedy. We also know that it's hard to detect patterns in fatality data for a reason for which we all should be 131 12/13/06 - PUBLIC HEALTH - RES. 060867 grateful. Though each is a terrible tragedy, let us be grateful every day that the number is low enough for it to fluctuate from year to year due to random chance. And let me just pause for a moment. While I have great respect for Mr. Cervone, I have to tell you, I think the methodology of focusing on the fatality cases by the Panel is a mistake. If you want to know what typically goes on, you got to look at typical cases. It would be far better if the mandate to that Panel was to do a case reading of a large random sample of cases so you could see across the board in a representative way how the casework is being done. There are better measures than fatality numbers. Most notably, the rate at which children left in their own homes are re-abused. By that measure, New York City and Illinois improved significantly as they reduced the number of children taken from their homes. And Los Angeles 132 12/13/06 - PUBLIC HEALTH - RES. 060867 County does far better by this measure than other California counties that take away far more children. In contrast, Philadelphia's "take the child and run" approach to child welfare did nothing to prevent the tragedies that have made headlines over the past two months. Doing more of the same will only lead to more tragedy. Why are children often safer in places that take fewer of them from their parents?