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?
In part, it's because workers in these places have more time to find the children in real danger who really must be taken from their parents. But it's also because most of the children seen by caseworkers are not who we think they are. Contrary to the common stereotype, most parents who lose their children to foster care are neither brutally abusive nor hopelessly addicted. Far more common are cases in which a family's poverty has been confused with child neglect. 133 12/13/06 - PUBLIC HEALTH - RES. 060867 Several studies have found that 30 percent of America's foster children could be home right now if their parents just had decent housing. And single parents desperate to keep their low-wage jobs when the sitter doesn't show may have to choose between staying home and getting fired or going to work and having their children taken on lack of supervision charges. Other cases fall on a broad continuum between the extremes. The parents neither all victim nor all villain. What these cases have in common is the fact that there are a wide variety of proven programs that can keep these children in their own homes and do it with a far better track record for safety than foster care. And we must never forget how harmful and how dangerous foster care itself can be, particularly foster care with strangers. When a child is needlessly thrown into foster care, he is 134 12/13/06 - PUBLIC HEALTH - RES. 060867 cut loose from everyone loving and familiar. For a young enough child, it can be an experience akin to a kidnapping. The emotional trauma can last a lifetime. One recent study of foster care alumni found they had twice the rate of post-traumatic stress disorder of Gulf War veterans and only percent could be 11 said to be doing well. 12 Another study found that even 13 infants born with cocaine in their 14 systems did better when left with mothers 15 able to care for them than they did when 16 placed in foster care. For the foster 17 children, the separation from the mothers 18 was more toxic than the cocaine. 19 A third study found that on 20 average foster care is such an inherently toxic intervention that even children who were equally maltreated but left in their own homes with little or no help fared better than children thrown into foster care. 135 12/13/06 - PUBLIC HEALTH - RES. 060867 All that harm can occur even when the foster home is a good one. The majority are. But the rate of abuse in foster care is far higher than generally realized and far higher than in the general population. That same alumni study found that one-third of foster children said they'd been abused by a foster parent or another adult in a foster home. Switching to orphanages won't help. The record of institutions is even worse. None of this means no child should ever be taken away. Of course there are children so brutalized in their own homes that the only option is to take the child and never look back. One of your colleagues today described a personal experience with such a case. But there are far fewer such children than generally believed, and the odds of finding them go down during a foster care panic. 136 12/13/06 - PUBLIC HEALTH - RES. 060867 My written testimony discusses the other half of the equation, the need to open the doors. We offer a transparency agenda for Philadelphia child welfare and a series of other solutions to the problems now plaguing the system. I would be pleased to discuss this with you and especially since, again, I have to disagree in part with Mr. Cervone. I believe the framework he is suggesting or seems to be getting at does not go nearly far enough. And I'd be pleased to answer any other questions you may have. Thank you.
Thank you. Thank you very much. I'll telling you, it's --
I'm glad that Madam Chair insisted that you come back so that we could hear your testimony.
It just 137 12/13/06 - PUBLIC HEALTH - RES. 060867 goes to show you this whole issue is very complex and there are no quick-fix answers to the situation that families find themselves in, and I think you point out, like Cheryl did, the societal issues that impact on families and that we have to find a way to address them. And certainly we have always in Philadelphia promoted the idea of keeping the child in the home, and I hope this panic of taking the children -- because the social workers do feel the way you cited, that it may be their next case, because they have to make those judgments. So I hope the panic will not continue. You said that the danger of foster care is particularly acute with strangers. What about when children are placed with their own families, such as we support kinship care here in Philadelphia?
That is a much, much better option. When you look, for example, at that Minnesota study I 138 12/13/06 - PUBLIC HEALTH - RES. 060867 mentioned that talked about how even the children who were equally maltreated and left in their own homes did better than the foster children, that was better than the foster children placed with strangers, what should best be called stranger care. Kinship care is still foster care, but it cushions the blow. Those Minnesota children left with kinship care did not do worse. Similarly, there are a number of other studies which show that kinship care placements are not only more stable, better for a child's emotional well-being, they are on average safer than stranger care. It's very important to emphasize that, because it's very easy to take cheap shots at kinship care, to use assumptions like, well, if the -- because of the same assumptions against the poor parents may extend to poor grandparents and people will jump to conclusions. We know that kinship 139 12/13/06 - PUBLIC HEALTH - RES. 060867 placements are on average safer. Allegheny County, of all their placements, not just all their family placements, nearly half are with relatives.
Now, in the kinship care model, does the support, the financial support, follow the child?
No. That's a huge problem. The way things are set up now -- and this is because of federal regulations and also the failure of states to step up to the plate to make up for it. The federal regulations say the following: If grandma wants to take in her grandchild, she can get the same kind of payment that a total stranger would get, but only if grandma becomes a licensed foster parent. Now, the problem with that is, the licensing requirements very often are geared to middle-class creature comforts, not necessarily health and safety. So if mom is poor, grandma is probably also 140 12/13/06 - PUBLIC HEALTH - RES. 060867 poor, and she may not be able to afford, say -- and I'm not saying these are the specific Pennsylvania regulations, but many states say a separate bedroom for every foster child, a minimum amount of square footage and so on. There are two ways to deal with this. Allegheny County's approach has been to move heaven and earth to get the kin licensed, provide the help to expand the housing, provide whatever they need. And they have managed to do this within the licensing restrictions. New Jersey has taken the approach of also -- I think they're also pushing for licensing, but they're also saying, If you can't get licensed, we'll make up the difference between, say, what you might have gotten on an AFDC child-only grant and what the federal government would pay you if you were a total stranger. We will reach into our own pockets in the state treasury and make up the difference, because it's that 141 12/13/06 - PUBLIC HEALTH - RES. 060867 important to promote kinship care. I recommend both approaches.
I'd like to just say for the record, you're absolutely correct in that Pennsylvania has fallen short to date of bridging the gap for kinship care providers, but the good news on the horizon is that State Senator Anthony Hardy Williams and State Representative Rosita Youngblood have -- Senator Williams actually has a bill in the State Senate where he's looking to garner support to make that bridge. So some attention is there, but ultimately you need adequate votes to make it real.
We started the whole issue of kinship care some years back. And when Ms. Hardy comes 142 12/13/06 - PUBLIC HEALTH - RES. 060867 back, we'll ask you about the whole kinship care program on the state, because we thought that the check followed the child and not to the parent here in Pennsylvania. So we'll talk about that.
No. As you say, if you're a total stranger, you will get a specified amount, but by federal regulation, if you are an unlicensed grandparent, you can't get that same amount.
So if the State makes an effort or gets the money to follow the child, will Pennsylvania be able to do that in lieu of this federal guideline?
The State is free to reach into its own pocket and make up the difference. Absolutely free to do that. The catch is, it's going to come out of the state treasury.
So my suggestion 143 12/13/06 - PUBLIC HEALTH - RES. 060867 is to approach it two ways, make a concerted effort to do what Allegheny County has done and get the grandparents and other relatives licensed, but also make up the difference when that can't happen.
You stated in your testimony, "two months ago the Philadelphia child welfare system had very serious problems. Certainly it was better than it was ten years ago, but much work remains to be done." Let's talk about the two months ago. Talk about that.
Okay. Well, one of the things that reflects the fact that much work remains to be done is the fact that almost -- by the way, Philadelphia is not unusual. Those systems that take away fewer kids and have better safety outcomes, they're the ones who have managed to succeed at concerted efforts to reform. So that if you looked at San 144 12/13/06 - PUBLIC HEALTH - RES. 060867 Francisco, it would be about the same as Philadelphia in terms of its rate of child removal. Akron, Ohio would be higher. Columbus, Ohio would be in the stratosphere. So all child welfare systems have very serious problems, even the ones that I call "national models" are national models not because they're where they need to be, but because they're so much better than most of the rest of them.
And cite some examples real quick, national model examples.
Yeah. The child welfare system in the State of Illinois, state run. Not because they don't have serious problems, but because they are doing better than most of the country. The State of Alabama, thanks to a class-action lawsuit -- co-counsel for the plaintiffs was one of my Board members. They brought a class-action 145 12/13/06 - PUBLIC HEALTH - RES. 060867 lawsuit. The Director of the Alabama system at the time, a man named Paul Vincent, welcomed the suit, used it as a chance to leverage resources and make reforms, and the consent decree involved rebuilding the system to emphasize keeping families together. They have done -- again, many problems remain, but significant advantage. And one reason it's important to mention Alabama, by the way, is, the person who was running the Alabama system at the time is a guy named Paul Vincent. He now helps other systems around the country to reform. He's done it in New York. He's the court monitor in Utah. In 2002, he came to Philadelphia and wrote a comprehensive report on revamping the training for supervisors in DHS. That report has been sitting on a shelf for four years. I haven't seen it, but knowing who wrote it, I'll bet it's pretty good. So one of the things I suggest 146 12/13/06 - PUBLIC HEALTH - RES. 060867 in my written testimony is take that report off the shelf and start implementing it.
Just one more. I will indeed read your testimony page by page. You mention the Minnesota study. You reference it. Are there details in here where one can actually get all the background on that?
If I can get from one of the staff your card, I will e-mail the actual study to you. There is a citation in there, but it --
Could you please make sure that the Chair of the Committee gets that, and she'll make sure that all of us do. I'd be very, very much interested in that.
One other question. Have you met with anyone at the Inquirer since their stories?
I asked to. I've 147 12/13/06 - PUBLIC HEALTH - RES. 060867 been here. I was able to meet with Commissioner Evans. I was able to meet with a wonderful group of union stewards and supervisors, who were very dedicated and were very impressive. I e-mailed, I think, most of the Inquirer reporters who have written most of the stories and asked if I could meet them while I was in town. Some of them said they were too busy. Some did not respond at all. Now, they have certainly received a number of e-mails from me. One reporter referred to them as harangues.
Harangues. But I think even if one has communicated by e-mail, there's nothing like a person-to-person meeting.
Well, maybe you won't get it this week today. You might get it tomorrow. If the panic ends, you say Philadelphia will be taking away more 148 12/13/06 - PUBLIC HEALTH - RES. 060867 children than other cities. What can be done about that?
And in your conversation, maybe I don't want to give up your conversation with Dr. Evans, but maybe you can share with us some of the discussion.
Well, one of the things would be to restore -- it is my understanding that there were a number of good ideas started up in recent years, and somehow they tend to fall by the wayside. For some reason, in the past Philadelphia child welfare seems to have been the place where good ideas went to die. For example, the family-to-family program, an initiative of the NEKC Foundation, which also funds my organization. As I understand it, Philadelphia was a family-to-family site, but it appears to have kind of withered away. I'm not saying it may not exist in some form in some way, but there's a 149 12/13/06 - PUBLIC HEALTH - RES. 060867 tendency for the model programs to be diluted. Intensive family preservation services underwent a similar phenomenon. One of the Alabama reforms --
That was our kinship care program, the family preservation.
Okay. Let me be -- well, I'm very glad you raised that, because it's very important to understand this. The term "family preservation" was originally invented about 32 years ago to apply to one specific type of intervention, something called intensive family preservation services based on a model called Home Builders in Washington state. One of the biggest mistakes the family preservation movement made was this: Home Builders is a trademark. The term "family preservation" isn't. So it can be slapped onto anything and everything. So when I speak of an intensive family 150 12/13/06 - PUBLIC HEALTH - RES. 060867 preservation services program, I'm speaking of that specific program, which Philadelphia also did have. It may even still have in some form, but probably, again, as a shell of its former self. In Alabama, they use something called flex funds, which means just what it sounds like, a small pool of money that a caseworker can use for a given family for anything that particular family needs, and it is amazing how much that one small infusion can leverage. My understanding is, Philadelphia once had it. Again, it's tended to fall by the wayside. So you can look at reviving those programs. You can bring that plan that Paul Vincent wrote off the shelf. And one last item, it tends not to be thought of as a DHS responsibility, bolster due process protections for families. Right now in most cases a birth parent who is accused and whose child has already been taken, you're at 151 12/13/06 - PUBLIC HEALTH - RES. 060867 that 72-hour hearing, they can walk in with a cardboard cutout wearing a three-piece suit and get about as much representation as most birth parents get now, simply because you are talking about overwhelmed, probably underpaid what are called panel attorneys, with no 9 institutional provider, no institutional support. Now, there are some cases that are handled by wonderful groups like Community Legal Services where you have that, but what they do should be the norm. And that's not a matter of getting bad parents off, so to speak. What it has to do with is, if the case doesn't belong in the system, you get it out so workers are free to look for the kids in real danger. If there are real problems, you have a dedicated advocate with their own support staff to push for whatever that family really needs. Washington state has done this in several counties. It has worked so 152 12/13/06 - PUBLIC HEALTH - RES. 060867 well that even the people who prosecute parents in that state are in favor of this program now, because it gets the cases that don't need to be there out, gets the families the real help that they need. So those are some of the -- and, of course, again, the whole idea of the transparency agenda.
My final question I'd like to close around Dr. Evans around, parenting workshops, whether or not that should be a criterion for when a child is returned to their natural family and/or this flex -- what did you call it?
Flex funds. Might incentives be a useful tool in helping parents -- and then I'm including myself in that so-called well-informed parents who are looking for the best methods in raising children. Should incentives be used prior to a 153 12/13/06 - PUBLIC HEALTH - RES. 060867 child returning to their natural family?
Okay. Couple of things. First, I would not -- the key to flex funds is using them at the very beginning of the intervention. So I don't think it would work as that kind of an incentive. You want to go right in and deal with the immediate pressing problems. I would also be reluctant on the other point, because paradoxically, one of the problems you tend to have in many child welfare systems now is, no 19 matter what the real problem is, you tend to see what would have been aptly called cookie-cutter service plans. Every plan says get counseling, get parent education, go to counseling, get parent education. Now, in many cases I'm sure that makes sense, but the key to real 154 12/13/06 - PUBLIC HEALTH - RES. 060867 reform is custom tailoring the plan to whatever that family really needs. So, therefore, there's nothing I would -- almost nothing I would favor in absolutely every case. Also, if you're going to do the parent education, it's a lot more effective if it's done as part of one of those intensive family preservation services programs, because then you have somebody who is combining hard services and concrete help with who is also qualified as a therapist to provide this kind of parenting education. If a family sees that somebody can deliver real help, they're going to be more receptive to the counseling. So that, for example, in one of these models, the counseling -- and the parent education may be done while mom and the therapist are fixing a hole in the wall, repairing a broken window, scrubbing the floor. They're combining the two. So that tends to make them both more effective. 155 12/13/06 - PUBLIC HEALTH - RES. 060867
Before you leave, could you briefly tell us about your agency and how you got started so we can put you in perspective. You did not have an opportunity to do that. We have the information here, but for the record, briefly.
Yeah. I am a former journalist. I covered my first child welfare story 30 years ago and I met a young woman. She was a college student. She had been in nine different foster homes by the time she was nine years old. She had emerged an extraordinarily articulate advocate because she had managed to keep the rage bottled up inside her, as she says, unlike my five brothers who have been in every jail in New York state. And I came out of talking to her 30 years ago with three conclusions: I was really glad I had chosen journalism as a career; I knew I would keep coming back to the story; 156 12/13/06 - PUBLIC HEALTH - RES. 060867 and if we just get rid of all those no-good birth parents and get all these kids adopted, everything will be fine. Well, two out of three is not bad. Now, I didn't reach that third conclusion because the former foster child said it. It was just the conclusion I jumped to. But after years of coming back to the story, I kept finding that piece was wrong. The facts on the ground weren't matching what the most widely quoted experts kept saying. So I learned there was a wider range of expertise out there. And when this dichotomy became too much to bear between what I was seeing as a reporter and what I was hearing from some groups of experts, I wrote a book about all this. That was 1990. That prompted a call from a wonderful woman I had covered when I was a reporter in Massachusetts, Elizabeth Vorenberg. She was a member of the National Board of the ACLU at the time. She said, You want to try to form 157 12/13/06 - PUBLIC HEALTH - RES. 060867 an organization around the principles in your book? I said, Sure. She got an initial organizing grant, and a mere eight years later, we got sufficient foundation support for me to take the only job I ever held that involves neither committing acts of journalism nor teaching others to do so.
Focus of our organization is to try to reform child welfare systems, to improve child safety by keeping more families together.
Spectacular. It's a long difficult process. I'm so glad you mentioned the no quick-fix piece of this, because it is very difficult, and one of the most important things as you embark upon this process here is to constantly monitor for results, but 158 12/13/06 - PUBLIC HEALTH - RES. 060867 expect it's going to take several years to get them. The success rate? We actually tend to work through by trying to change media coverage. So in some places, we've been quite successful. In others, notably less so. But I would point to, for example, the State of Maine where not because of us alone but because after a child known to the system died in a foster home -- when children die -- there's a double standard. If the death is in his own home, people always think, Oh, it must be doing too much to keep families together. If the child dies in foster care, it's, Oh, it's a technical thing, fix the licensing standards and the background checks. Well, we persuaded Maine media to look at the fact that that state was taking away -- or had in foster care on any given day more kids than almost any other state in the nation. And Maine is not the child abuse capital of America. 159 12/13/06 - PUBLIC HEALTH - RES. 060867 So when the media were willing to look at this, the public officials followed, and when a new Governor came in, he brought in a new reform-minded administration, and working together with a wonderful foster parent who had become fed up with the fact that so many of the foster children she was seeing could have remained in their own homes, she organized the grassroots, and today the State of Maine takes away 30 percent fewer children than it did five years ago. They've doubled the proportion in kinship care, and they've done it without compromising safety. We sure as heck didn't do that, but we working with these other groups, I think, were pivotal in that. We accomplished more modest success, but some reductions in Missouri as well.
Thank you so much for coming up, and we will certainly share your testimony with all members of the Committee and actually 160 12/13/06 - PUBLIC HEALTH - RES. 060867 with all members of City Council, because we will have our budget hearings beginning in February and the Department will come back and certainly the same issues will be discussed at that time. And so we appreciate your taking time to come up. Thank you very much.
What I'd like for you to do, you do have a lot of details about process --
Well, I'd like you if you could try and sum up and just give us a little bit about DHS and what is your role to try to help the local office with some of the issues, 161 12/13/06 - PUBLIC HEALTH - RES. 060867 because you have a lot of the people in here who know your process and we can read that. So we appreciate that.
And I'm not going to be nearly as eloquent as he was. I always end up in this position. Somebody sings ahead of me and then I go. But let me see what I can do to cut down on some of this.
If you go to and talk about your policy on death abuse, that would be helpful.
Yeah. Why don't I do that, which is actually where I left off. One of the things that our report actually produced this last year for 2005 was that statewide 40 children died as a result of abuse or neglect. Seventy-five percent of those deaths were of children under the age of five, and parents were the most frequent perpetrators of those deaths. And of those 40 child deaths, 21 of the families 162 12/13/06 - PUBLIC HEALTH - RES. 060867 with a child death were known to a county child welfare agency. For the City of Philadelphia, there were deaths in 2005. 6 Let me see if I can't cut some 7 of this crap out of here, because it's 8 going to sound so bureaucratic, and go to 9 some of the things that I've heard that 10 have been raised by some of the other -- 11
-- some of the 14 other people. 15 The one thing that's important 16 to understand in Pennsylvania is that -- 17 and I don't know if this is necessarily how it will always remain, but that is that it is a state-administered, county-operated system. So we've got 67 counties that are basically doing their own services. I have visited 60 of those 67 counties and I believe that a county-operated system is a system that 163 12/13/06 - PUBLIC HEALTH - RES. 060867 can more focus on how children -- the needs of the children, because, believe me, all 67 counties are very different and they all need to be very creative in how they provide services based on the needs of the kids in those -- the children in those particular areas. There are some specific laws that are important that I thought I should mention, and one is the Pennsylvania Child Protective Services Law, which includes the parameters for investigations. And that's the reports of suspect child abuse as well as reports of children in need of general protective services. These services include incidents where there is inadequate shelter, truancy, inappropriate discipline, hygiene issues or other issues impacting the well-being of a child. County agencies are charged with investigating these reports under 164 12/13/06 - PUBLIC HEALTH - RES. 060867 the Child Protective Services Law. Allegations of abuse are received and registered with the ChildLine. They are then forwarded to the appropriate county agency. County agencies must immediately respond to the safety of the child within hours. It's important to note that 9 the majority of the reports that come to 10 the attention of the county agencies do 11 not rise to the level of child abuse as 12 defined by law. 13 Agencies have to complete their 14 investigations between 30 and 60 days. 15 During the investigation, the caseworker 16 visits the family as often as necessary 17 in order to determine safety. 18 Let me see where else I can -- 19
If I could 20 ask you some questions, it would 21 stimulate the discussion here. 22
Because I 24 do have some. How often are the counties 165 12/13/06 - PUBLIC HEALTH - RES. 060867 evaluated?
At least once a year. What types of evaluations has Philadelphia received over the last few years and what has been the status of the license issued by the State?
That is a very good question. Actually, Philadelphia has had a fairly good track record in the last two years now. My position, I've been the Deputy for two of those evaluations. So I've signed off on two evaluations for Philadelphia. In both of them there were no, what I would call, serious types of issues related to the licensing. There's always issues, because we're very -- we're bureaucrats and that's our job, to figure out what are the counties not doing that are in the regulations. But both of the licensing visits required corrective actions, which were provided by Philadelphia 166 12/13/06 - PUBLIC HEALTH - RES. 060867 immediately, and the corrective action plans were accepted by the Department of Public Welfare. I think one of the things that we haven't been as good at as we should be, and that's following up on those corrective action plans. I think that we've been less of a good partner to DHS than we might be by not perhaps holding their feet to the fire on those kinds of bureaucratic issues, when the most important things for them to do is to take care of the safety of kids. But at the same time, in those corrective actions, there are things that need to be implemented, not just because of the regulations but because it's good practice. So the last two there have been corrective actions. They were submitted timely and there were no major deficiencies that were in those licensing -- they're called licensing inspection systems. 167 12/13/06 - PUBLIC HEALTH - RES. 060867 Did that answer your question?
That's fine, but the inspection, which goes into the issuance of the license, would your inspection have identified the problems with the provider?
It looks at all of the regulatory requirements that are issued. And I actually have with me, because these are public information, the last two licensing corrective action plans. So if that's something that the Council would be interested in having, that is public information. We talk about non-transparency, but that is public information. And they look at all sorts of things. I was actually going to bring this up with me, because it's very specific, very bureaucratic the kinds of things they look at. I'll just pull the most recent one out for you, give you kind of a sense of the things that we look at when we come in. 168 12/13/06 - PUBLIC HEALTH - RES. 060867 We look at the areas around placement and whether the placement records that are reviewed are accurate and complete. And that's a certain part of the chapter in the regulations that we look at. We do a lot of record review stuff to make sure that what is required by the law is included in there, like family service plans are updated and that they're signed and that the parents have signed them and the parents have seen them. We don't look at the -- we have a list of the agencies that are contracted by the City, but the contracting between the City and the agencies is really between the City and the agencies.
Do the agencies have to be licensed by the 169 12/13/06 - PUBLIC HEALTH - RES. 060867 State?
There are certain agencies that do have to be licensed by the State, and there are some that don't have to be licensed by the State. One of the agencies, unless they do services other than the SCOH services, they are not licensed by the State of Pennsylvania. Now, if they do other services that are other than the in-home SCOH services, then they do have to be licensed. So if they're doing --
So you're saying the SCOH service providers are not licensed by the State?
If that's the only thing they do. If that's the only service that they provide.
But if they do other services, you don't review the SCOH services; you do the other stuff?
That's correct. That's correct. And it's one of the 170 12/13/06 - PUBLIC HEALTH - RES. 060867 things that we've thought about since this, whether it wouldn't be helpful to the counties, particularly to Philadelphia, for us to take a look at developing some kind of a licensing criteria or standard. Now, the counties have that. I mean, they have contracts with the agencies, and there are standards in their contracts, but we don't do the licensing or the certifications of those providers.
Now, do other counties in the State contract with providers like Philadelphia?
Yes. It's the same thing. Matter of fact, when -- I'm not sure if it was Dr. Wexler, but when Mr. Wexler was talking about Allegheny County, it sounded a little bit like he was talking about it as another state in itself and that it does things that Philadelphia couldn't do, and that isn't true. Philadelphia and Allegheny are 171 12/13/06 - PUBLIC HEALTH - RES. 060867 bound by the same kinds of regulations as it relates to kinship care, as he had mentioned. So that things that are being done in Allegheny County around kinship care can be done in Philadelphia around kinship care as well. So those are the kinds of things we look at. It unfortunately as I look through this over the last year and becoming familiar with it, it has a tendency of being a little more bureaucratic than practice-oriented, and one of the things I think that we need to do -- and we have to do it based on the law, of course -- is take a step back and look at some of the practices as well so that we can be more helpful to the counties and say, In this county this is some of the good practice that is occurring, you might want to think about doing this in your county as well. But those are basically the licensing -- so we go through the adoption services -- and, by the way, you 172 12/13/06 - PUBLIC HEALTH - RES. 060867 had no violations on adoption services. We go through the general protective services. We basically just go through the regulations and say yes or no. Protective services, are you following the requirements in the protective services. And like I said, over the last two years, the LIS's for Philadelphia were not anything to be concerned about.
What are some of the child abuse rates in other counties in the State and are there counties relative to their population that have maybe higher death rate or child abuse rates than Philadelphia?
Well, if we're talking about deaths rates, I mean, you guys are huge.
You're 54 percent of our system. So when I give you the statistics about 40 deaths and you having 173 12/13/06 - PUBLIC HEALTH - RES. 060867 percent -- or 17 out of those 40 deaths in 2005, it really isn't -- I mean, that isn't out of whack for the State and for the deaths that occur. Unfortunately, what I left on the train was the annual report, but I do have one that I can leave with you.
That goes through a 11 lot of statistics based on all the 12 different counties, with a lot of 13 information on there that you can do a 14 comparison based on what you would like 15 to know instead of me telling you. 16
Well, are 17 there some counties that have higher death rates than Philadelphia?
I know it's all relative, but if you have a county with 17,000 people where you have a death rate of 50 kids, that's --
No. It really is 174 12/13/06 - PUBLIC HEALTH - RES. 060867 based on the percentage. I mean, here out of 40 isn't even 50 percent, but yet the number of kids that you serve in your system are much, much higher than that percentage of deaths. I think Allegheny -- I'm looking here to see. Allegheny County may be the next -- no, it's not.
Erie County 13 struggles as well, and they've had the 14 same kinds of issues, and we've been 15 working with them on the same kinds of 16 issues. So Erie County is a little out 17 of whack for the number of kids that they serve. As it relates to abuse cases, you guys have the most abuse cases, but it's not out of whack with a city your size and the kinds of services you're providing and the poverty that exists in the area. One of the points that I 175 12/13/06 - PUBLIC HEALTH - RES. 060867 thought Mr. Wexler made that was really well is, the bottom line for a lot of these families is the poverty that they live in, and until something is done about that, there's not going to be a whole lot of improvement in the outcomes for some of these children. So I will leave this for you.
And if you would like copies of the licensing reviews, just let me know. I'll be glad to provide that as well.
I would like to, just because we talked a lot about transparency, I'd like to skip back -- well, first, before we go there, for death reviews, there are some very basic things that the Department of Public Welfare does, and it's in my testimony.
We'll put 176 12/13/06 - PUBLIC HEALTH - RES. 060867 that in the record.
There are four different types of processes that we go through for death reviews, and you can read that yourselves, but I'd like to talk a little bit about the transparency issue, because the Governor has just signed into law a bill. It's actually related to our Child Abuse Prevention and Treatment Act. It's CAPTA. The bill 12 itself is known as Act 146, and it was signed by Governor Rendell on November 9th. And this was a lot of work by a lot of people to try to create to bring Pennsylvania into some federal requirements, draw down some additional dollars, but also this law provides for the release of information. It allows for public disclosure of the findings of information about the cases of child abuse or neglect that has resulted in a child fatality or near fatality. So this will allow all of the counties to provide that information, where currently there 177 12/13/06 - PUBLIC HEALTH - RES. 060867 isn't a law that allows that. Matter of fact, there's a law that prohibits it. So that takes effect 180 days from the date of signature, and that's November 9th is when he signed it. So I did want to make sure I mentioned that, because I think that's very important.
Could you just explain to me about the kinship care program in Pennsylvania and what the law allows for children remaining with families and the resources that go with that?
I will do the best I can on this. Unfortunately, I may even ask one of my partners from Philadelphia to come up and explain it, maybe Joe. But let me take a crack at it and maybe Joe can fill in where I miss out. Kinship care is, of course, as you know, very similar to foster care, and in Pennsylvania in order to be a kinship care provider, you do have to be licensed as a foster care provider. 178 12/13/06 - PUBLIC HEALTH - RES. 060867 I'm not sure -- I mean, that's been in the law. I'm not sure it isn't something we couldn't look at based on some of the information that Mr. Wexler provided. But a kinship care family does receive what a foster care family would have received for that child.
In Pennsylvania, yes. Yes. So when you talk about the money following the child, I'm not sure exactly what you mean by -- you didn't just ask that question, but I heard you mention it before.
Well, in 1998, we had a conference here in Philadelphia on kinship care, and as a result of that, the Department opened up a grand central station where they provided support and help and information to family members who wanted to take on the raising of a family member, because with the advent of crack cocaine, we saw 179 12/13/06 - PUBLIC HEALTH - RES. 060867 a lot of mothers leave their children with family members. And at that time, the assistance check went to the parent, and we wanted to -- and I thought that the financial resources went with the child to the family. So that was a long time ago, but that's how we set it up. And I don't know if this is talking about what Mr. Wexler was talking about, the family to family or family preservation, but the Department got -- and Julia Danzy was extremely important, played a role in setting up the information department called Grand Central Station to help families understand what kinship care meant.
I happen to believe exactly what he said. I agree that kinship care is the best for children if you can find them, but I think in a lot of situations, and I'm sure here in Philadelphia, it may be difficult to find kinship care in situations when the whole 180 12/13/06 - PUBLIC HEALTH - RES. 060867 family has been in a generation of poverty forever. And a lot of times it's generational, the families that are served by DHS. But it is a better way to go. It is less traumatic for kids. And we do pay the families for kinship care, but, yes, he's right, they do have to be licensed. But Allegheny has figured out a way to do it, as he said.
Well, we'll work with Allegheny. Maybe the Commissioners will do that. Thank you very much. I have some other people who are waiting also.
-- before I go? Because I do really want to put a plug in for DHS and for the fact that I truly 181 12/13/06 - PUBLIC HEALTH - RES. 060867 believe that the DHS administrators and the staff, for the jobs that they have to do every day to protect the children and families, do an excellent job. When they were talking earlier about firemen, policemen and child welfare workers having the toughest jobs, I'm not so sure I'd put it in that order. I think that being a child welfare worker in this country is one of the most difficult jobs you could possibly have and sometimes one of the most thankless. So I really do want to mention that and say what a good partner DHS has been with us. We sometimes make their lives very difficult, but in spite of that, they really have partnered with us well. So I wanted to make sure I said that.
Well, we thank you, and we've been here a long time and have worked with DHS, and they've come a long way, and we are proud of them, too, on what they do. 182 12/13/06 - PUBLIC HEALTH - RES. 060867
And the other thing I created when I started was an advisory cabinet, and Philadelphia was one of the counties that sat on my cabinet. Cheryl Ransom-Garner was one of the members of my advisory cabinet, and now I'm looking to DHS to provide another member.
Let me now have Rita Urwitz, Tamara Askew and Kahim Boles. Thank you so much for being patient. I don't know if you're familiar with the hearing process here in City Council, but with the questions, it gets pretty long, so we ask you to come prepared and bring your lunch.
I think we're 183 12/13/06 - PUBLIC HEALTH - RES. 060867 prepared.
Okay. Good afternoon. Whoever is going to begin first, please identify yourself for the record.
Good afternoon. My name is Tamara Washington-Askew.
Nice to meet you. Would you like to proceed with your testimony?
Yes. Good afternoon, Madam Chairperson and members of the City Council. My name is Tamara Washington-Askew. I am employed as a Social Worker II within the Department of Human Services. I have been with the agency three months shy of eight years. In those years, I have worked in three sections. The first section I worked in was in the General Intake section. The Intake section is fast paced in regards of keeping time mandates with the State 184 12/13/06 - PUBLIC HEALTH - RES. 060867 of Pennsylvania. In this particular section, a social worker has to be able to investigate Child Protective Service and General Protective Service allegations of abuse and neglect, assess for safety, secure safety if needed and document findings, complete several required forms and determine the case between 30 or 60 days. This is easier said than done, because social workers may encounter barriers or obstacles that may prevent the case from being closed or transferred for services within the mandated time frame. Cases are not assigned one at a time in Intake. When I worked in the Intake Unit for three years, I received eight to ten cases a month. There were four Child Protective Service cases assigned on an emergency day. I was expected to transfer or close eight to ten cases as fast as they were assigned. I managed to keep a low caseload. However, it was very stressful mentally, 185 12/13/06 - PUBLIC HEALTH - RES. 060867 emotionally and physically. In Intake, you see the full gamut of poverty and/or abuse and neglect in families. As a social worker with compassion, I felt compelled to save and help everyone. However, often times I could not, for whatever reason and efforts that were made. But I could not dwell on the families/children that refused to be helped or the judges or child advocates that refused to see the whole picture. Sometimes I felt like "who am I? " And for what? Only to get my testimony thrown out of the window, especially in a courtroom. If one chooses to get stuck there, it makes the job more stressful. So you have to keep on and move on and keep investigating, transferring or closing cases. I often did not sleep because 186 12/13/06 - PUBLIC HEALTH - RES. 060867 some cases kept me second-guessing my determination. I would ask myself sometimes why. How could a family be made stable on one day, only to be in a complete crisis the next day? I had to keep telling myself that I am not God and I do not have a crystal ball. I made the best decision I could make, considering all the factors involved at that time. I was asked by my Director at the time to consider working in the specialized section of Sex Abuse Intake. I worked in this section for three years. I also received a series of training for this section. Working in the Sex Abuse section was not as challenging as General Intake, in my opinion. In this section I was supported by a team that consisted of DHS supervisors, DHS administrators, medical personnel from Children's Hospital and St. Christopher's Hospital for Children, the Special Victims Unit, Philadelphia Children's Alliance and the 187 12/13/06 - PUBLIC HEALTH - RES. 060867 District Attorney's office. I felt as though I was making a difference in the lives of the victims and the non-offender caretakers. This was rewarding, because my efforts to provide safety and render support and services did not go in vain. I was able to earn the respect from DHS management as well as child advocates and the judges for my efforts. But this was in the capacity of working in the Sex Abuse Unit, in a specialty unit. Currently, I am in the Family Preservation section. I get to be a part of helping to preserve the lives of children and their families. It is refreshing to be able to see a family go from a helpless crisis mode to a feeling of empowerment within 12 weeks. Often times the families are not given a second chance. Family Preservation Services gives the family a second chance to get it together.
Instead of dwelling on their past mistakes the family has made, 188 12/13/06 - PUBLIC HEALTH - RES. 060867 we are able to build on the strengths of the family and enhance them. I was also a parent action network co-facilitator. In this capacity, I was able to give back to the parents what I have learned over the years and help them. These parents were able to graduate from the group with a feeling of accomplishment of learning how to be a more effective parent. Although I can only speak for myself, however, I can speak to the job in which the social workers at DHS are expected and required to perform. The majority of us work very, very, very hard, without question. Most of our good deeds go unnoticed and unknown to the public, administration, the court personnel and the press. Many of us have gone above and beyond the call of duty to secure the safety from one child to several children in one family. Many of us have sacrificed the time that we could have spent with our own biological 189 12/13/06 - PUBLIC HEALTH - RES. 060867 children. Yes, it is unfortunate when a child dies. As a social worker, a piece of us also die. It is not fair to be judged by the outside public and press. Theoretically, everything regarding policy and practice sounds great and doable, but in reality, if I have said it once, I have said it a thousand times, if you have never done this job, you will never understand. Every family is unique and has their own set of unique problems. Therefore, they should not be treated the same. The same holds true for the DHS personnel. We should not be stereotyped as an agency and be placed under the scrutiny of the world for one person's mistake without a full-scale investigation of all the factors that are involved. I thank you very much for this opportunity to testify today.
Thank you 190 12/13/06 - PUBLIC HEALTH - RES. 060867 very much. We'll wait until you all have spoken, then I have some questions.
Good afternoon, Madam Chairwoman and members of Council, and thank you for this opportunity to speak to you on this important issue. My name is Kahim Boles and I am the Secretary/Treasurer of AFSCME Local 2187 as well as a social worker at the Department of Human Services in the Family Preservation Unit. I have been a social worker at DHS for ten years, of which the last seven years has been in the Family Preservation Unit. As such, I have had the opportunity to work with many clients who are in crises and in need of the most intensive services provided by the Department. I am here today to speak on behalf of the many social workers who work at the Department of Human Services. These workers have dedicated their lives to protecting the children of 191 12/13/06 - PUBLIC HEALTH - RES. 060867 Philadelphia. The workers at DHS have a very difficult task to fulfill. Many times they are asked to knock on doors that police would ask for back-up. Every year, DHS social workers will visit homes on New Year's Eve when people are intoxicated and may be armed to inquire as to the safety of their children. Yet, social workers continue in spite of the potential dangers. This clearly speaks to dedication. While we welcome this opportunity to take a good look at the way services are provided, we are very concerned about the way we have been portrayed in the media as of late. There appears to be a trend to blame the social workers for all the problems facing the Department at this time. The problems at DHS can be fixed. However, they will need resources to do this. We need to have more resources to assist our clients. Without 192 12/13/06 - PUBLIC HEALTH - RES. 060867 concrete resources, all of the visits in the world will not change the problems in the homes. Many times workers feel their job is akin to building bricks without straw. We as social workers of the Department of Human Services have a great responsibility, and we are well aware of what that means. We are also aware that we cannot let poverty be an impediment to keeping families together. However, many of the families that we work with are in need of even more resources than we are now able to provide. In the past, we were able to assist our clients with housing if that was the need. We are no 18 longer able to do this in the vast majority of cases that we have even though this may be the primary need. In fact, a large percentage of the families that we serve are in need of concrete services such as housing, rental assistance, utility assistance, job placement and drug and alcohol services. 193 12/13/06 - PUBLIC HEALTH - RES. 060867 It is our sincere hope that the final result of this process is a commitment by everyone to increase our ability to serve families. Thank you for this opportunity to offer testimony, and I would be happy to entertain any questions you have.
Good afternoon, Madam Chairwoman. Thank you for this opportunity to testify. I am Rita Urwitz, Vice-President of AFSCME Local 2186. I represent supervisors who work in the Department of Human Services, among other departments. I feel uniquely qualified to testify today because of my long history with DHS. I began my career at DHS in 1980 as a caseworker with 250 children in my caseload. Before I took leave in 2002 to work full time at the union, I was 194 12/13/06 - PUBLIC HEALTH - RES. 060867 supervising five social workers in the Family Preservation section. In fact, at that point in time, we were the Home Builders model. It was a wonderful experience, and I had the great honor to supervise Mr. Boles. It saddens me to watch what I believe to be the unwarranted Inquirer attacks on the Philadelphia Department of Human Services. The impact on an already overburdened and demoralized staff is devastating. Over the last years, DHS has 15 gone through many changes. Philadelphia 16 County offers more services and broader 17 services than other counties in 18 Pennsylvania and, in fact, in the nation. 19 Yet, it's not nearly enough. In times of 20 shrinking dollars, systems are challenged 21 to find new ways to provide services to 22 conflicted families facing complex 23 systemic issues. Most of our families 24 are impoverished. 25 Mental health services are not 195 12/13/06 - PUBLIC HEALTH - RES. 060867 always accessible. It's harder to get children into special education programs. It's very difficult, if not impossible, to access shelter services. Families are turned away after waiting all day and told to return to wherever they slept the night before. They frequently don't come back. While none of these systemic problems can excuse the death of a child, the system that is in place to protect each child and to provide support for the family is overwhelmed. Twenty-six years ago, services to children in their own homes included several hours in the home each week with a private provider social worker and a family care worker. In 2006, that same service, Level 3 SCOH, mandated two contacts during the week with no time requirement. Hopefully that will change. I am not sure of how or when that happened. Until around 2002, DHS did its own resource development and 196 12/13/06 - PUBLIC HEALTH - RES. 060867 closely monitored services. One social worker was charged with finding and developing community resources. She had this big board, and it was fun to go up there and just find tutoring services, all different services that were available in neighborhoods and in churches. When that social worker retired, the position was not filled. Other resource development staff investigated needs and developed new services. Monitoring staff were responsible for ensuring that an agency was meeting its mandates and providing the services expected by the agency. While monitoring staff still exists within the agency, a decision was made to disband the Resource Development Unit. Today, DHS, a $700 million agency charged with providing services to Philadelphia's most vulnerable children, does very little resource development of its own. In 2005, the City announced 197 12/13/06 - PUBLIC HEALTH - RES. 060867 layoffs. To avoid laying off critical staff, DHS gave up vacant program analyst positions. As program analysts left, their positions remained unfilled. Those positions were the positions responsible for monitoring agencies. DHS fell behind. Also facing the City is a violence and truancy plague. DHS was assigned the task of impacting youth violence, a task that would take somebody many, many hours to do a week, a full-time position, probably several full-time positions. Yet, this Commissioner, Cheryl Ransom-Garner, was expected to do both jobs, be the Commissioner of the Department of Human Services and also meet the mandates of the anti-violence youth program.
Our resources competed -- really had to be shared with the anti-violence and truancy initiatives. The deaths reported by the Inquirer are tragedies. DHS as part of a 198 12/13/06 - PUBLIC HEALTH - RES. 060867 larger system must accept some responsibility. However, the Inquirer also has a responsibility to report the whole story. How and why, not just what. And we have a responsibility to be open and transparent -- that seems to be the word of the day -- so that the public can understand that the system is not doing well and is in desperate need of public scrutiny and assistance. Some have argued that more children must be placed. Yet, Philadelphia has one of the highest placement rates in the nation. 4 children for every thousand impoverished children. That number does come out of a DPW report, but Arthur Evans testified earlier and really didn't have the benefit of or the opportunity to really explain that number, and so I'd like to do that in a 199 12/13/06 - PUBLIC HEALTH - RES. 060867 very short -- or just capsulize it. That number is a federal number, and they look at children placed in a 24-hour period, and frequently children are taken out of their homes. It's still a tragedy and it's still devastating to a child, but a child is taken out of their home for a very short period of time, perhaps because there is another place for a child to go, and the child is returned in 48 hours, maybe with court activity. Sometimes a parent doesn't always agree to accept service, so a child may be removed for a very short period of time and returned at the court date with services. 4 percent number. Actually, in reality, the placements in Philadelphia are lower. If we look at a snapshot in time, today we place fewer children than we did a year ago. And I believe the Department can provide you with that information, but I really wanted to make that clear and be 200 12/13/06 - PUBLIC HEALTH - RES. 060867 on the record, because those numbers get confusing and I really wouldn't want the public to think we run out and just snatch children, because it isn't what we do. It isn't what we want to do. And certainly Philadelphia really does offer more services than many of the counties around Philadelphia. So I wanted to clear that up. I also want to say that what's necessary sometimes to place a child -- there's been a lot of talk in the newspaper articles about placement, and there certainly is a school out there that believes that a child should be placed immediately. They even talk about orphanages. I think that I've interviewed and dealt with thousands of children in my career at DHS and I've yet to meet a child that felt good about being taken out of the home. Mostly children just want their families fixed. Perhaps children who have suffered injury and death have a lot to 201 12/13/06 - PUBLIC HEALTH - RES. 060867 tell us. In the wake of tragedy and desperation, there is opportunity. The Department needs staff, money and other resources so that a system that is already far ahead of other systems can catch up with those systems in other states whose reforms have resulted in fewer placements and lower re-abuse. You will hear some suggestions. I offer a few. One, maintain funds -- and this goes to the heart of the flex funds. Maintain funds that social workers and their supervisors can easily access for such items as beds, special programs, clothing, emergency rental payments, housing concerns and all of the expenses that support family stabilization. Housing is a very serious issue in the City of Philadelphia, and I think children sometimes get placed because their parents can't do better and we can't help them do better. I'd like to see the Resource Development restored 202 12/13/06 - PUBLIC HEALTH - RES. 060867 within the Department as a separate unit. I'd like to develop more quality monitoring systems.
Not paper systems, but a real partnership with the private provider that looks at services and then defines the needs and then plans those services. To expand safe programs that keep families together. I'd like to see family preservation and the old model of SCOH developed again and put in place at DHS and the Home Builders model of family preservation. Family preservation, even if it isn't the service -- if you're not going to actually do that as a treatment service because sometimes a family needs much more than that, it's a wonderful assessment model, because it tells you about the extended family. It tells you -- when you talk about kinship care, it tells you about grandpa up in New York that you would never know about. I mean, it tells you how the family does everything. So as an assessment model, 203 12/13/06 - PUBLIC HEALTH - RES. 060867 it's a wonderful model.
It's changed. I think, again, shrinking dollars, more cases coming in, pressures in the Department, fewer dollars for flex funds.
What's the total funding of money taken from the Department to go to other programs?
I don't know the answer to that question. I would have known that years ago. I don't know today. I know what we spent on our family preservation dollars, and I do not believe that it was expanded, and that 204 12/13/06 - PUBLIC HEALTH - RES. 060867 was five anyway -- I started in 1993 and in 2002 when I left, it was the same amount of money, and I know that between 1993 and 2002 costs went up. I believe it's the same amount of money now. They had to do the flex funds out of their money. It was built into the program funding. So as inflation took place, as problems became more severe, I think a lot of the service changed.
So you say there are families that -- and we certainly heard a lot of discussion today about the plight of the families, the poverty that exists. There needs to be some way to provide some resources to these families.
A little bit more than they may get if they're on assistance.
Absolutely. I mean, Welfare to Work has had a major 205 12/13/06 - PUBLIC HEALTH - RES. 060867 impact on families.
Well, families have to make a decision. Parents have to make a decision do they stay home with their children, do they raise their children, do they go to work and risk us taking their children because there isn't anybody to care for their children. The society itself today has created a lot of barriers to family preservation and to preserving family -- I mean, the values have changed in our society and the money has changed, and philosophy follows money. That's reality. Other things that I would like to see is, I'd like to see -- Richard Wexler mentioned Paul Vincent, who did some years ago come to Philadelphia. Alba Martinez brought him to Philadelphia. He did a study of the agency, and his conclusion was that the 206 12/13/06 - PUBLIC HEALTH - RES. 060867 Department of Human Services had to do significant training of supervisors. The supervisor line is very important. It's the professional line. Not that the rest of the agency isn't professional, but it is the line that guides the practice in the agency, and it needs significant -- they do need significant training. We have been working on that training, actually. Actually, we began to do that with Cheryl before she left, and we've been working with June and looking at what training is necessary, but Paul Vincent gave a plan, and that plan was put on the shelf. We have taken it off the shelf and are beginning to look at it, and I will approach the management about implementing it. It's a plan that will take three years. One of the problems is, anything that's really worthwhile doing that will create institutional change takes a very long time, and folks are reluctant to start something that takes a 207 12/13/06 - PUBLIC HEALTH - RES. 060867 very long time not knowing if the funding is going to be in place for it. So that's one of the reforms we really do have to implement. So I'm suggesting that. And I'm also asking that we closely examine all programs and initiatives and support services within the agency for efficacy and efficiency. Frequently in any bureaucracy, programs get started, folks get invested in it and they just stay, don't know what they're doing. So I think that this is an opportunity for this agency to really begin to look at itself and look at everything that it's doing, should we have specialized caseloads. When I came into the agency, we were divided up based on agencies. Like I had very specific -- any child that went through a specific agency, I had. So I knew the agency well. Today, cases are divided up across the board and like in the case like multi-ethnic, if they 208 12/13/06 - PUBLIC HEALTH - RES. 060867 had 100 cases, it could have been 80 workers they had and that don't necessarily talk to each other. So nobody really knows that there's a pattern going on. And that's something we might want to look at, how we design that now. Some folks feel that generic is better because it's good to have a handle on everything. I think it's time to look at that, and I'd like to see that happen in the agency. I think there's a lot of will to do that. Certainly Dr. Evans has begun to have those discussions. I'd like to bring together the key stakeholders. We used to have meetings with the private providers, supervisors, workers, private providers, have focus groups and look at the services and look at how we might work better together. I'd like to see that happen again. And, again, with transparency, I'd like to educate the public. I'd like 209 12/13/06 - PUBLIC HEALTH - RES. 060867 to have some town hall meetings and encourage public debate and community responsibility. We can't do this job alone. It really does take a village and it takes the entire community to begin to impact poverty and child abuse. Thank you.
Thank you so much for your testimony and for your information. I just have a couple of questions. I'd like to go back to Ms. Askew, and I'll come back. You talked about you have to close cases in a mandated time frame?
Yes. In working in -- well, in all the entities within the Department of Human Services, we are under certain time mandates. If you're assigned -- I'm only going to address working Intake, because that's where a lot of the pressure comes in 210 12/13/06 - PUBLIC HEALTH - RES. 060867 regarding time. You receive a CPS report. You have 30 days to make a determination on that case, because you have certain paperwork that you have to complete. It's a form called a CY-48 that needs to be completed with your determination whether abuse occurred, abuse or neglect occurred. You're given 30 days to do it. Sometimes you may be given extra time regarding the circumstances, if you're waiting for a coroner's report or if you're waiting for a doctor to get back with you, but for the most part, it has to be done -- a determination has to be done within 30 days. With the GPS, it's more of a General Protective Service report. You're given 60 days to make the determination. Within that time, you have to go out to do the investigation. You have to make sure the children are safe. You have to complete the paperwork. And in the Intake Department, 211 12/13/06 - PUBLIC HEALTH - RES. 060867 it's like triage in a hospital. You assess and -- well, this is in-house terms, assess and move, because you can't hold onto a case -- well, you should not in the Intake Department. You're primarily there to assess safety, document and move the case within a certain time frame, because that's your main job in Intake. If the case needs further services or if you place the child in foster care or kinship care, that's when you move it onto the Family Service region or you make referrals to maybe community-based or Family Preservation, where I am now. But you're not supposed to hold onto these cases. That's not your job as an Intake worker. I mean, it's very -- I'm not going to say difficult, but it's sometimes challenging, because you have to be a social worker, at the same time doing field work, and also -- you're a social worker, you do field work and you 212 12/13/06 - PUBLIC HEALTH - RES. 060867 also have to do paperwork. So there's a lot of things that you have to do when you're in the Intake Department. So you have to be very efficient, because you can't go over having so many cases on your caseload, because the cases keep coming in. Regardless if you were able to transfer or close these cases or not, you're still required to get your amount of cases for that month and to do the same thing on each and every case. And every case you need to go out and do the best job, as best practice as you can as far as social work and ensuring the safety of the children and still come back in the office and do the paperwork and everything else that you have to do.
How does this impact on the quality of care or quality of service?
It does impact on the quality of service, I believe, because how much social work can you really do when you have these 213 12/13/06 - PUBLIC HEALTH - RES. 060867 mandates on you to do the investigation, make a determination and make sure the case is moving in its right direction in the agency, whether you're going to close it out or whether you're going to transfer it? So you're really not being -- I try -- like I said, I only can speak for myself, and it's very, very stressful when you have to -- you want to do the best job possible. You want to save these children or you want to fix what's going on, and you're doing this, you're doing everything that you need to do, but in the mean time, the clock is still ticking for you to move this case. So you try to do as much as you can in the short amount of time that you have, and then hopefully that your case is going to transfer to another unit with someone that's going to do the exact same thing that you did and not see the case another way and go another way with it. It can impact on the quality of 214 12/13/06 - PUBLIC HEALTH - RES. 060867 care, because you don't have the time that you would like to have to do everything within that family that's needed, because if you do, then you're going over your time mandates and then the case is out of compliance, and then you have to deal with whatever comes after that.
Let me ask you another question. You talked about the court and your testimony being thrown out the window. Would you elaborate a little more on that?
Elaborating on court. Often times, once again, you go out and do an investigation. You're there. You see it. You hear it. You know what's going on. You go to court. You try to explain your position to all the parties that are involved, the child advocate, you have your attorney, you have the City Solicitor that's speaking for you. The 215 12/13/06 - PUBLIC HEALTH - RES. 060867 child advocate is there for the child, advocating for the child. You're there also advocating for the child, but also for that family. You may have determined that the child may need certain things or the mother is capable of doing certain things, but the child advocate is there just for that child. And we're still talking about children, but they're going on what the child wants. Children don't know what's in their best interest sometimes, but that's their position, because they're the child's advocate. So you're trying to present yourself to the judge, having them understand where you're coming from, because you're actually the one that's out there and often times the child advocate social worker only sees that child a day of court or the day before court, when you've actually been out there, have been working with this family for maybe 30 days. And then you go to 216 12/13/06 - PUBLIC HEALTH - RES. 060867 court. You're presenting yourself, and then you don't have an agreement. The child advocate sees it one way; DHS sees it another way. And when, like what's going on now, when we're under scrutiny, what we're saying, it's not even being heard, because we have a lot of people that's trying to save face. So because of DHS had the eyes and ears, everyone is looking at us, then what we're saying really doesn't matter. And often times that has been the case. And when you have judges just looking at what's presented before them and going on what they think should happen, without actually knowing what has happened and have made snap judgements, snap decisions, sometimes you have removed children from dangerous situations from homes, only to have the judge return the children back home to have something happen to them all over again, and then another report is made, then you're back in court again. 217 12/13/06 - PUBLIC HEALTH - RES. 060867
Thank you very much. At least we'll get some idea of the kinds of -- we haven't had you here in a long time in terms of issues around DHS, and we certainly hope that -- it seems that Dr. Evans is trying to sit with you to work with you on some of the issues that you've raised. Hopefully that some of the changes -- it's a very big department, very complicated, but that your input should be there as you wrestle with some of the issues that you deal with.
I want to say that there's no question that probably Dr. Evans is very tired of speaking with us. He speaks with us frequently. He's been a great partner. In this time -- Cheryl was a good partner, too. Cheryl was really there also. We had total access to Cheryl, when the Mayor didn't pull her away from the agency. But Dr. Evans has taken over this agency. I mean, for a guy who really had no child 218 12/13/06 - PUBLIC HEALTH - RES. 060867 welfare background, and I was a little skeptical at the beginning, he knows systems and he really does involve everybody and he listens, and hopefully we will move ahead now.
Thank you very much for your testimony. We appreciate it. We'll have you back in the spring during the budget session so you can bring us up to date on what's going on. Next we have our final panel, and I hope they're still here. We thank you for waiting. Margaret Zukoski, Christina Kirchner and Katherine Gomez. Every time you come to City Council, bring your lunch, always. Thank you so much for waiting. You've heard the testimonies. We appreciate your coming. Whose article did I read yesterday in the paper about DHS?
Was it Cathy Carr? Yeah, my Executive Director. 219 12/13/06 - PUBLIC HEALTH - RES. 060867
Good afternoon, Madam Chairwoman. I am Margaret Zukoski and I am the Associate Director of the Pennsylvania Council of Children, Youth and Family Services. The Pennsylvania Council is a statewide membership association comprised of 130 private child welfare, juvenile justice and behavioral healthcare agencies that collectively employ over 20,000 individuals. On behalf of our members, I thank you for this opportunity. The Pennsylvania Council supports its members by advocating for responsive and accessible services through our work with the state and local public child welfare agencies, the State Legislature and other key stakeholders in the child welfare system; by providing 220 12/13/06 - PUBLIC HEALTH - RES. 060867 professional development and staff training opportunities; and analyzing and sharing information that impacts child welfare service delivery. Pennsylvania Council members work with children who are at risk or who have been abused or neglected, as well as with their families. They do this through a wide variety of services, including prevention services, SCOH services, foster care, residential, behavioral health and drug and alcohol programs. Many of our member agencies also provide educational services, early intervention programs and other community-based programs for families. Approximately 60 percent of our member agencies contract with the Philadelphia Department of Human Services, and 84 percent of DHS's funding is designated for payments to private agencies for the delivery of purchased direct prevention and social work services. 221 12/13/06 - PUBLIC HEALTH - RES. 060867 The provider community in Philadelphia, as has been mentioned several times today, has been serving abused, neglected and dependent children for well over 100 years, long before the public sector services were mandated. The private sector remains a fundamental part of our current service system, not only by delivering contracted services to thousands of Philadelphia's most vulnerable children and families, but also by contributing millions of private dollars to support shortfalls in appropriated funding for publicly mandated services. Today, we are here because of the tragic deaths of children involved in the child welfare system. As you are aware, two children died during the time a private agency was under contract with DHS to deliver services to the children and families. Upon hearing this, the provider community was shocked and saddened. These deaths, however, have 222 12/13/06 - PUBLIC HEALTH - RES. 060867 started what can be defined as a moment where the child welfare system has the opportunity to identify and correct gaps in service that undermine the safety and well-being of Philadelphia's children. While current news articles portray a provider system that has universally failed to protect children, this is not an accurate depiction of the work done by the majority of fine private providers who are dedicated professionals committed to delivering quality, effective and responsive services to fragile families. Families receiving SCOH services face a myriad of problems. Frequently, as you have heard, they are living in poverty, struggling with substance abuse, domestic violence, mental illness and woefully inadequate housing. Because of SCOH services, children who are at risk of being placed in foster care have been able to remain in their homes with their safety and well-being being monitored by providers, 223 12/13/06 - PUBLIC HEALTH - RES. 060867 while the provider is simultaneously working with their family to strengthen their ability to care for their children. The lives of thousands of families and children have been positively affected as the result of SCOH services. Tragically, the stark reality of child welfare interventions is that there are times when you can do everything right, implement every support available and still have a tragic result.
Notwithstanding this harsh reality, the child welfare community and the collaborative systems are working together to remediate the factors that lead to abuse and neglect and to improve policies, practices and interventions so the likelihood of child maltreatment is reduced and eliminated. The Pennsylvania Council and its members are working wholeheartedly with both the Philadelphia Department of Human Services and their own agency staff to ensure the safety, well-being and 224 12/13/06 - PUBLIC HEALTH - RES. 060867 permanency of children under their care and supervision. In addition to the efforts of individual agencies to ensure safety through their ongoing regular home visits and provision of services, at the request of DHS, providers recently completed a comprehensive report on each of the 8,000 children in Philadelphia receiving SCOH services. This report was completed to document that each child's health, education and other special needs and the status of services to address those needs were identified and met. Provider agency social workers work long, late hours and weekends to complete this huge undertaking in two weeks' time. Providers will support and assist the efforts of the Mayor's Child Review Panel, the safety and well-being assessments being conducted by DHS, the quality service reviews that will be coming underway by DPW's Office of Children, Youth and Families and the in-depth service reviews which will be 225 12/13/06 - PUBLIC HEALTH - RES. 060867 conducted by nationally recognized child welfare experts. The Pennsylvania Council has also convened special meetings of its SCOH Provider Work Group to discuss how providers can both support DHS efforts and tighten our own safety net for children. This work group, which has been meeting on a monthly basis for more than years, is comprised of senior 12 program directors and supervisors from 13 SCOH programs. Members meet regularly 14 with DHS staff to discuss SCOH policy and 15 practice concerns. It has been a wonderful forum for advancing practice. Providers in recent years have worked closely with DHS in implementing the Family Assessment Form, a nationally recognized assessment tool which not only tracks a family's progress over time, but also helps the provider worker identify and respond to risks in the family. Also, over the past several years, DHS and providers have achieved 226 12/13/06 - PUBLIC HEALTH - RES. 060867 great successes in helping children and families in other key areas, and Dr. Evans referenced these. The implementation of wide-scale community-based prevention services, which DHS contracts with private providers to deliver, have contributed to decreases in the number of children needing formal child welfare services. Additionally, through the implementation of performance-based contracting in foster care, which began in March 2003, the number of children in foster care has dropped nearly 15 percent. The PBC foster care model has driven an 84 percent increase in the permanency rate for children and a 50 percent increase in stability in placements as compared to 2002. Simultaneously, the number of children reentering care after having been reunified with their family has decreased dramatically. DHS and the provider community will continue to work together to bring the same intensity of 227 12/13/06 - PUBLIC HEALTH - RES. 060867 focus and collaborative spirit to efforts to ensure that SCOH services reflect best practice and positive outcomes. The Pennsylvania Council has appeared before City Council on several occasions. Typically, we come before you to offer comment on DHS's budget requests. In March of this year, we offered testimony on DHS's funding year '07 budget. We testified that providers have experienced funding shortfalls in all aspects of doing business, from administration to service delivery. Double-digit inflationary increases have been incurred in operating health insurances, transportation and utilities.
These and other direct costs of doing business have increased for providers without commensurate increases in rates paid by DHS for purchased services. In reviewing the system shortfalls, we would be remiss if we did not identify here today to you our serious concerns related to the purchase 228 12/13/06 - PUBLIC HEALTH - RES. 060867 of service and payment mechanisms for providers. The ability to recruit and retain staff and support responsive and flexible services is directly linked to adequate compensation. Just as competitive wage scales are critical to retention, so are opportunities for training and support for continued professional development and skill refinement. Opportunities and funding for private provider staff to access relevant training remains a serious challenge. Pennsylvania Council leadership has met with Dr. Evans to address concerns. We deeply appreciate his openness to hearing the issues and effort to begin to identify constructive solutions. Given the serious and complexity of the current environment and the urgency for corrective actions, the private provider community stands ready to offer resources in terms of experience and expertise held by the leadership 229 12/13/06 - PUBLIC HEALTH - RES. 060867 within the private agencies. I extend this resource, as well as the staff of the Pennsylvania Council to be part of the solution-focused efforts to address the challenges we share in the child welfare system in Philadelphia. Again, I thank you for this opportunity on behalf of the members of the Pennsylvania Council.
Thank you very much. And in case you may have to go, I just have two questions for you, I believe. Are all of the providers, all agencies who provide SCOH services, a part of your Council?
Is there a membership cost? 230 12/13/06 - PUBLIC HEALTH - RES. 060867
Do you know the percentage number of agencies in Philadelphia who might be members of your organization that do exist and provide -- do you know the agencies which provide SCOH services and those agencies which are members of your organization?
Yes, I do. Thirty-two SCOH programs in Philadelphia are members of the Pennsylvania Council. I believe at this time there are approximately 42 agencies providing SCOH services. So the vast majority of agencies providing SCOH services are members of the Council and are active members in the SCOH Providers Work Group.
And you do provide training and information and stuff like that?
Yes, we do. We provide a staff training program, which is one of the benefits of our membership. 231 12/13/06 - PUBLIC HEALTH - RES. 060867 Our members can access low-cost high-quality training at a reduced fee. Unfortunately, Councilwoman, our agencies are not able to access the same level of training that DHS workers are. DHS workers have approximately -- they take the core training course that the State mandates. That's 120 hours of training over months. In Philadelphia, even 11 before a DHS worker is really out in the 12 field, they have 12 weeks of extensive 13 training. 14 The way the SCOH providers are 15 paid for service, which is on a per diem 16 basis per case, doesn't allow them the 17 flexibility or the resources to provide 18 that level of in-depth training prior to workers being in the field, although they do a terrific job through means such as their own in-house training, sharing training with other provider agencies and using the Pennsylvania Council.
Thank you very much. 232 12/13/06 - PUBLIC HEALTH - RES. 060867
I guess let me ask you another question. How many of your members have had complaints filed against them? Is it a large percentage or a small percentage?
I know at this point of the one agency that was named in the paper was a member of the Pennsylvania Council.
Good afternoon, Madam Chairwoman, and thank you for allowing me to offer my comments today. They're a slightly different note than our recent speaker. But I am Chris Kirchner and I am the Director of the Philadelphia Children's Alliance, and we were founded in 1989 to improve the way that child sexual abuse cases are handled in the City of Philadelphia. Original founders of our agency included leaders 233 12/13/06 - PUBLIC HEALTH - RES. 060867 from DHS, the Police Department Special Victims Unit and the Office of the District Attorney, and we're located out of 40th and Chestnut Street and we've been serving there since we opened our doors in 1990. In Philadelphia, the Department of Human Services documents an average of 160 reports of alleged child sexual abuse per month, and Pennsylvania state law requires that the majority of these reports also be investigated by the Police. When allegations of sexual abuse are reported to either DHS or the Police, a myriad of services must be activated, and the degree to which the service providers collaborate is often key to a successful outcome for the child and family, as well as the lowest cost to society. It is not always easy to ensure collaboration in a city the size of Philadelphia, thus our mission is to create a coordinated multi-disciplinary 234 12/13/06 - PUBLIC HEALTH - RES. 060867 professional response that brings healing and justice to abused children. We benefit children by providing a safe, comfortable, child-friendly facility, with an effective interview process and support services. We provide the following services: We oversee joint Police/DHS interviews where investigators from both agencies attend and partner with one of our child interview specialists who conducts an interview using protocols developed to meet the needs of both DHS and the Police, hoping to reduce the number of times that kids have to be interviewed about very sensitive information. All of our interviews are recorded, and copies of the recording are made available to the investigative agencies. Written reports of all child interviews are also provided. Crisis counseling for non-offending parents, referrals for 235 12/13/06 - PUBLIC HEALTH - RES. 060867 emergency medical, legal, financial and therapeutic services are offered. Case tracking through a database and case review meetings with all team members ensure that information is shared throughout the life of the case. We also offer training for professionals in team building, forensic interviewing and related subjects, and we currently have a grant from the Justice Department to provide training and technical assistance to communities in the northeastern United States that are hoping to develop a collaborative response in child abuse cases. There are many benefits to a comprehensive approach to child abuse interventions, some of which were recently documented in a study out of the Center for Policy Research in Denver, Colorado, which found that joint child welfare/law enforcement investigations had some of the following benefits: More 236 12/13/06 - PUBLIC HEALTH - RES. 060867 contacts during the investigation, more frequent in-person interviews with everyone involved in the case, more perpetrators removed from the home, more perpetrator confessions, more frequent victim corroboration, more substantiated reports and dependency filings, more criminal prosecutions and more guilty pleas. In other major cities across the country, including Chicago, Houston and Brooklyn, programs like the Children's Alliance have played a pivotal role in enabling different agencies to overcome barriers to collaboration in both child sexual and child physical abuse cases. However, one of the most effective strategies used in other locales, especially large urban environments, to forge and institutionalize collaboration is the physical co-location of the public and private agencies that are involved in the response. 237 12/13/06 - PUBLIC HEALTH - RES.
060867 Co-located programs in other cities have demonstrated dramatic improvements in the provision of services to children and families, including more services, shorter response times, more comprehensive investigations, higher client and professional satisfaction, and increased community awareness and responsiveness. In Chicago, 145 professionals -- that includes law enforcement officers, social workers from their DHS equivalent, prosecutors, medical and mental health providers -- are co-located in a 22,000-square-foot facility built solely for that purpose by the city, serving 3,000 children per year. In Houston, 200 professionals are co-located in a 52,000-square-foot facility that serves 3,400 children per year. In Brooklyn, the development of the co-located Children's Alliance program was prompted by the death of Eliza Esquierdo in 1995 -- former 238 12/13/06 - PUBLIC HEALTH - RES. 060867 Commissioner Timoney led that development of that co-located program -- when it was determined that failure of police and child welfare to collaborate, partly because they were prohibited from doing so by state confidentiality laws, contributed to the child's remaining in a dangerous situation. To date, Philadelphia has accomplished an unprecedented level of cooperation and coordination among representatives from child welfare, law enforcement, medical and mental health communities, although at the Children's Alliance we only see one in four cases of child sexual abuse with a coordinated response. Building on the positive experience that we've had thus far, since 1990, we now stand ready to lead a greater level of collaboration to assure that critical services are available to abused children and their non-offending family members by developing a co-located program on the campus of Episcopal 239 12/13/06 - PUBLIC HEALTH - RES. 060867 Hospital at Front and Lehigh Streets. When the Special Victims Unit of the Philadelphia Police Department moved into its current space about five years ago on the campus of Episcopal Hospital, it was with the intention of creating a co-located program with DHS, Police, PCA, the Children's Alliance, and a medical clinic staffed by our children's hospitals on site for the purpose of further coordinating investigations among all agencies. We've been working on that initiative for the past five years. We had all gone looking for new space for SVU when they were house-hunting hoping to find a facility that could accommodate all of us, and in the Episcopal site, we found that facility. But we've been delayed by various barriers, but as we understand it now, the City is negotiating with Episcopal to lease the entire building, permitting the Children's Alliance to occupy the lower level and the 8th floor, 240 12/13/06 - PUBLIC HEALTH - RES. 060867 the Department of Human Services the 5th, 6th and 7th floors, with Police remaining on their existing floors one through four and the medical component housed in the lower level with the Children's Alliance. Space for the Children's Alliance will include adequate interview, observation, counseling and team meeting and training rooms. We project to have five interview rooms with five observation rooms so that DHS and the Police can partner with our child interview specialists in conducting high-quality child interviews so that we can serve all of the City's children for whom allegations of sexual abuse have been made in a state-of-the-art facility using a collaborative approach. While we are optimistic based on what we've heard recently that co-location will move forward, we want this project to become a reality in 2007. The Police Department, the Department of Human Services and the District 241 12/13/06 - PUBLIC HEALTH - RES.
060867 Attorney's office have all voiced their support for a co-located program, and it is against this backdrop that we look forward to partnering with public and private stakeholders to assure that child sexual assault investigations are conducted in the most effective and efficient way possible with the best outcome for the child, the family and the community. I am happy to answer any questions, and I hope that you and members of this Committee will help us to make a co-located child abuse response a reality in Philadelphia. Thank you.
Yes. Thank you very much. Good afternoon, Chairwoman and members of --
It's not that I don't have any questions for you. 242 12/13/06 - PUBLIC HEALTH - RES. 060867 I mean, you spelled it out pretty well, so it's just sort of like a little follow-up review with you. Okay?
Good afternoon, Chairwoman and members of the Committee. We greatly appreciate the opportunity to testify before you today. My name is Katherine Gomez. I'm the Managing Attorney of the Family Advocacy Unit at Community Legal Services. For the past years, the Family Advocacy Unit has 15 been representing parents, both providing 16 advice and also doing individual legal 17 representation at 1801, Dependency Court, 18 for thousands of parents over the years. 19 I'm here to speak on behalf of 20 our clients. The vast majority of our 21 clients are low-income African-American 22 or Latino single parents, who are 23 committed to being good parents to their 24 children. With services like Family 25 Preservation and SCOH, most of these 243 12/13/06 - PUBLIC HEALTH - RES. 060867 parents are ultimately able to meet the needs of their children. So I'm here to represent that population and to make clear that despite the accounts in the newspapers, really the overwhelming majority of parents that are in the dependency system are parents who are not brutal, are not horrible, are not evil, honestly want to do a good job parenting and are seeking assistance and are open to assistance and, with assistance, can properly parent their children. I will not read my testimony verbatim. I know you have it. I just want to highlight three points that is not really the subject of much public discussion, so I just want to hit on them. One is, we cannot separate risk and safety assessment from the quality of family preservation. When we have meaningful services in the home, it affects the safety of that family and how we assess safety for that family. The 244 12/13/06 - PUBLIC HEALTH - RES. 060867 key is not so much -- we talk about words like services, services, services, but what does it actually mean? We talk about SCOH. The key here is not just that SCOH is coming out to the home and ensuring that the child is safe, but that SCOH is actually doing something for that family to help that family sustain safety once SCOH is long gone. So what they're actually doing in that home is key. And so we emphasize that whatever evaluation happens with regard to SCOH, and we applaud those evaluations, but it really focuses on what skills do the SCOH workers possess, what are they passing on, what are they teaching these families who are desperately in need of assistance. It's our experience involving thousands of families that SCOH services when properly implemented can be an invaluable tool. We've seen numerous instances where SCOH has made a critical difference that has kept families 245 12/13/06 - PUBLIC HEALTH - RES. 060867 together. I just want to give a brief example. In a particular case, we represented a mother who had four children. One of the children was injured by the father while visiting with the father over the weekend. Mother did everything appropriate. She contacted the Police. DHS got involved. When DHS got involved, they noticed that there were problems with mother's home. Mother was poor. She had utility problems. She barely had furniture. Her rented apartment needed serious repairs. Another child in the home appeared to have developmental delays. DHS asked the mother if she would accept SCOH services. She accepted. And, thankfully, the SCOH worker who was assigned to her was very savvy, met with her weekly for several hours, taught the mother how to budget money, taught the mother how to assemble documents to get a better and more 246 12/13/06 - PUBLIC HEALTH - RES. 060867 affordable apartment, taught the mother how to negotiate a lease and helped the mother negotiate the lease. She located community groups that provided after-school programs and made sure that the children were enrolled in after-school programs and camps. She helped the mother locate different resources for her developmentally disabled child, made sure that the assessments happened, made sure that mom followed up with those appointments.
By the time the SCOH worker had closed the case, this family had made such tremendous progress. They reached a point where not only did they have better and more appropriate housing, they were connected to other community resources. She taught the mother how to find ways to make the children's lives better, how to be -- she helped empower this mother to make change and to continue with that change. And that's exactly what we mean by quality SCOH services. 247 12/13/06 - PUBLIC HEALTH - RES. 060867 This particular SCOH worker had several years of experience. She had a sophisticated understanding that every family is different. She saw what this family particularly needed and was nuanced in her approach to this family. She also had a good handle on how to navigate City systems. There are some bureaucracy that needs to be navigated when you're trying to get services, and the SCOH worker was able to do that. She had the interpersonal skills. Even though this SCOH worker was not of the same race as this client, she had the interpersonal skills to gain the young mother's trust, to empower her, to put her at ease so that the mother was open to receiving this help. Philadelphia's families need a more consistently effective, accountable and confidence-inspiring SCOH service to emerge as a result of whatever reform efforts we do. 248 12/13/06 - PUBLIC HEALTH - RES. 060867 The other issue that I want to touch upon is placement panic. Now, I have had the benefit of coming last in speaking today and so I have heard different people describe whether or not placement panic is happening. It's my -- before I get into statistics, which I got from DHS, I want to say anecdotally, we're in court every day, and in the last three months, we have seen a significant rise in the number of detentions coming into court and the number of times DHS is requesting for children to be removed from their homes, and that concerns us. So regardless of how you want to read the statistics, anecdotally we feel that it's happening, and we see it. Now, the data we've received indicate that there's been a 100 percent increase in the number of restraining orders filed and that there's been an overall of 23 percent increase in the total number of first-time placements of children. Now, these numbers maybe over 249 12/13/06 - PUBLIC HEALTH - RES. 060867 the course might seem like a blip, but I think it's very troubling given that it was a spike in a short period of time after certain news coverage, and I think that's basically the definition of placement panic. And placement panic is dangerous because when we talk about removal and we talk about placement, those are bureaucratic terms for what we mean by going into somebody's house, taking their child away abruptly, removing that child from their mother, their siblings, their home, their neighborhood, their school, their church and, more often than not, putting that child with a succession of strangers. That is powerful. That is a radical act, and we should be very careful when we take that step. And it's very easy when you're in this work every day to forget what a radical act that is. It's also easy to forget that the court system, as a general matter, once you pass the preliminary stages, 250 12/13/06 - PUBLIC HEALTH - RES. 060867 you're in court every five months. So mistakes like that are hard to correct and may take months to correct, and that impact will be felt by that child. And I'm not going to go into foster care outcomes, because I think my colleague on the national level, Richard Wexler, covered that. I just want to be sure that any efforts we take, we should make clear that we don't tolerate an environment where placement panic is okay, even if it's short lived. We won't tolerate it. It's not okay. We are responsible, the child welfare system, all of us. It's not just DHS when we talk about placement panic.
All of us are implicated, that we won't tolerate that and that the child welfare system is responsible not just for the child's physical well-being, but also for their emotional well-being. Finally, I want to end on the note that there's been a lot of talk about SCOH, but SCOH isn't the only 251 12/13/06 - PUBLIC HEALTH - RES. 060867 service that DHS provides. DHS provides many wonderful services, some better than others. And I think that that's part of our task, is to do an honest evaluation of programs, support and give business to the programs that work, expand them, duplicate them. That's part of our charge. DHS in the last several years -- and Dr. Kuna has been a big part of that. We have to be very grateful for DHS's openness. In the past several years, DHS has said, We want to solve problems, tell us what problems exist and we want to work with you on coming up with solutions and creating programs that work. So we have been happy with a lot of the initiative DHS has taken, and we hope that in the current climate, programs and family preservation and taking initiative and taking chances, that all of these things aren't shut down because we're scared. 252 12/13/06 - PUBLIC HEALTH - RES. 060867 Finally, I just want to end with the obvious, which is, in Philadelphia when we talk about removing children, when we talk about preserving families, what we're talking about is how we deal with poor people, their families and the troubles with their families. We can't divorce poverty from this whole issue. You know, for most of these parents, when they need any type of assistance, whether it be assistance that DHS provides or whether it be some other systems, substance abuse or mental health treatment, because of their poverty, they have nowhere else to turn but City agencies. So the quality and the accessibility of those services is so key to helping these families, both before they get involved with DHS and while they get involved with DHS. So we've been a big proponent of front-loading services and making high-quality services available. But 253 12/13/06 - PUBLIC HEALTH - RES. 060867 that remains a tremendous task, a task that is largely out of DHS's hands, but not out of the City's hands. Thank you, again, for this opportunity, and we just want to end with the final plug of quality services are extremely important, because even when we're not looking at the subset of parents, the sort of larger scheme shows that there are close to 100,000 parents that benefit from DHS services. So the quality of those services is key. It's key to keeping children safe, not just in the most vulnerable homes, but there's a wide spectrum of homes. So we should sort of keep going back to that focus, that it's not just that somebody shows up at the home, but actually what services are they providing to make sure this family gets better. Thank you.
Thank you very much. And certainly working with the Council here on the training of the 254 12/13/06 - PUBLIC HEALTH - RES. 060867 workers to have a better range of training and understanding of what's needed in a family is very important. I really thank you for your testimony. Did you present written testimony?
I didn't see that here, but we thank you. We'll make the entire testimony part of the record. We thank you for your testimony. And before I call Dr. Evans back, because I have one question for he and the Deputy, is there anyone else here to testify on this resolution? (No response.)
Thank you. We'll probably see you in the March budget hearings. I think you all should come back and give us an update on what's going on. Dr. Evans and to your Deputy, and I have to apologize to him because I keep forgetting his name. 255 12/13/06 - PUBLIC HEALTH - RES. 060867
You heard about this placement panic, and Ms. Gomez mentioned the increase in the number of children coming out of the home now. What's your take on that?
Well, the Department has looked at the issue of placement and the number of kids placed out of home, for several years has been actively trying to bring those numbers down. We look at some data -- and I have some charts that I can show you that show that, I think it was, in 2003 the number of children placed outside of the home was in the 7,500 range. Today it's in the 6,100 range. So it's been a steady decrease over the last several years. We take a point in time snapshot at the end of each year and at the end of each month. At the end of '06, the fiscal year '06, which would have been June 30th of this year -- I 256 12/13/06 - PUBLIC HEALTH - RES. 060867 don't want to quote numbers, but the numbers have gone up slightly from that time point, but even today, the number of children placed outside of the home is less than it was in January of this year. So it is true that we have had an increase. It is not, from what we can see, what other major cities have experienced when they've had this kind of media coverage, which I think is a testament to the Department and to the workers and to the leadership of the Department. My executive team, which has gotten ahead of this issue a little bit, what we want to see -- and it looks like right now the trend has at least attenuated. I won't say that we're starting to go back down in terms of the overall number of placements, but it doesn't seem like that there's this major panic increase that you see in other systems.
So the workers have not gone back to their files 257 12/13/06 - PUBLIC HEALTH - RES. 060867 and said, Oh, I've got to get this child out of the home because we're under scrutiny from the paper?
You know, I don't know what the individual practice has been, and, again, there has been some increase, but I think what's really important is for the staff to feel like they are supported. And the way we've approached the media and all of the coverage of the Department has not been to overreact, and I think people sense that. I hope they feel supported by that. And it's not that we're not going to look at these cases and figure out what happened and if there were mistakes, but the way we're approaching it is very measured. I think it's very balanced, and we have put the emphasis on trying to make sure that kids in the system are safe, and I think that goes a long way of creating an environment where people can make the best judgments that they can in these cases. 258 12/13/06 - PUBLIC HEALTH - RES. 060867
Well, I certainly thank both of you and all of you who have come to testify today. I think the point that has been made throughout the day by most of the people who have presented testimony is that we have problems, big problems, which we all talk about here in the City of Philadelphia. That is one of poverty, lack of employment, and we need to look at how we address the prevention. So people who are working and they are in good housing and they can pay their bills are less prone to be violent, which we have the other issue of violence on the other side because of all the social problems. You come in as sort of "I got to save these kids." They don't start with you. You receive them. And so your role and your challenge is great. We wanted to just have this discussion, because we would have had it on October the 25th, didn't have an opportunity to have it. We will continue 259 12/13/06 - PUBLIC HEALTH - RES. 060867 the discussion. I don't know whether it will be prior to the budget, but certainly we invite those who testified to come back and give us your take during the budget process when the Department of Human Services will present their testimony, because a lot of the reform measures that they want and some of the services that were outlined by the Council which are needed in terms of training and increase of contract, payment of services to these providers, they all have budget issues. And so we have to look at your budget when you bring it in here to see if you're adequately funded to provide the services that are needed, particularly the training and the resources that some of the individuals talked about. So it's extremely important that we get feedback at the budget time, and you certainly hopefully will be able to wade through all of that.
Well, we appreciate 260 12/13/06 - PUBLIC HEALTH - RES. 060867 that. We appreciate the opportunity to be here and particularly the spirit in which the meeting has been carried out. Any information that you need, please feel free to let us know.
Thank you. We will recess this Committee hearing until the call of the Chair. Thank you. (Committee on Public Health and Human Services adjourned at 3:20 p.m.) - - - 261 CERTIFICATE I HEREBY CERTIFY that the proceedings, evidence and objections are contained fully and accurately in the stenographic notes taken by me upon the foregoing matter on December 13, 2006, and that this is a true and correct transcript of same. ______________________________ MICHELE L. MURPHY RPR-Notary Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)