Written by Lori Jacocks & Lisa Mathey
The Child Welfare Advisory Committee (CWAC) meeting was held on June 15th. VDSS representatives shared updates on several foster care processes and policy recommendations.
Title IV-E Review Process
One of the first updates focused on the Title IV-E review process, which is a major funding source for foster care and adoption services. The Federal Government conducts state review of the Title IV-E process every 4 years. VDSS stated Virginia usually fails the Government’s review. However, the state is making progress towards consistently passing the review as is evident in 2016. Virginia passed the review for the first time with only one error. Virginia’s next review will be conducted in 2019. At that time, the Federal Government will perform a review of cases that are open during a 6-month period from October 1, 2018 to March 31, 2019. If Virginia fails the primary and secondary review, it is subject to a 10% penalty of the $210 million coming from Title IV-E. Virginia is currently at a 23.45% over all error rate statewide with most errors in “Safety Requirements” (43% error rate) and “Ineligible Expenditure” (28% error rate). Possible reasons for the high error rate could be attributed to staff turnover. Localities have had 75 director changes over the last 4 years. Also, most of the errors occurred in Benefits units than Social Service units. Some issues causing errors included not completing the VEMAT at the right time, incorrect pro-rating or payments, placing children in unlicensed child care centers, and lack of or incorrect clothing receipts for clothing vouchers. Another contributing factor to the errors is the process of completing Title IV-E eligibility by hand. The state is developing COMPASS to help reduce the errors and to better manage the eligibility process. The Families First Act is adding a new program to Title IV-E. An update on this new program will be given at the next CWAC meeting.
Child and Family Services Review – Program Improvement Plan Updates
The next update focused on the Child and Family Services Review (CFSR). In early 2018, Virginia completed a state-led review of 10 local agencies in all 5 regions. The review showed Virginia is not in substantial conformity but is generally made to be that way as the point is to see what areas need improvement. Those areas are permanency, resource family and kinship care, and CPS safety. The Federal Government has requested a Root Cause Analysis on everything in Virginia’s improvement plan. The State is developing a survey to go to local staff to look at barriers to performing their job and finding resources and tools that will be helpful to them. The State is using a Rapid Response team comprised of local Foster Care, CPS, and Adoption experts to develop questions and collect responses within a day from localities so that issues can be identified directly from workers instead of just trying to determine the barriers from the state level.
The CSFR also included the implementation of the Child and Family Service Plan(CFSP). The goal of this 5-year state plan is to align all plans (Child and Family Services, Child and Family Program Improvement Plan, Court Improvement Program) so that all are on the same page for system-wide improvements. There is a plan to have the PIP signed and approved in September, so it needs to be completed by July/August 2018. The PIP will drive Virginia’s child welfare for the next 3 years. Virginia will avoid a $1.55 million penalty if the PIP is approved in September.
JLARC Study of Foster Care
Drew Dickenson, Principal Legislative Analyst and Project Leader introduced participants to the Joint Legislative Audit and Review Commission (JLARC), a non-partisan, research arm of the Virginia General Assembly. JLARC can be assigned any topic to determine how initiatives are going and how they can be done better. This year, JLARC has been assigned to research adoption and foster care. They will be in the research phase through September. JLARC is looking to speak to social workers and foster and adoptive parents to gain their perspective of the system as part of the study. They will be presenting their findings to the legislature in December 2018.
Foster/Relative Home Approval Process
An update on the foster/relative approval process was provided. Since 2008 Virginia has had a 6% approval rate of relatives. States that are doing it right are at about 30%. The approval process should be closer to 50 – 60%. VDSS stressed relatives should always be considered first. If children can be living with relatives prior to the foster care review, they can be closer to permanency at the 12-month mark. VDSS needs to discover what the barriers are to approving relatives. Some agencies shared that they have a lot of relative placements that are outside of foster care — meaning before children enter care (diversion), but there are relatives out there who are taking custody at the end of foster care who were not certified as foster parents. Relatives not having barrier crimes is a challenge. Other states have different approval processes for relatives than for stranger foster parents. In Virginia, the process is the same. Local agencies need to be made aware that they can purchase TFC services for 60-90 days or whatever is needed to help with emergency approval of and assisting relatives in obtaining child care, beds and other items before the placement of the child.
Psychotropic Medication Management Policy Recommendations
Psychotropic medication management policy recommendations were also presented. Over-prescription of psychotropic medications to children in foster care is a big issue. Medicaid data shows Virginia is one of the five worst states in over-prescription. Virginia’s top two priorities that came out of a sub-committee workshop in April are: 1) how hard it is for the worker to challenge a psychiatrist and 2) many medications are prescribed by primary care physicians (PCPs) who have less knowledge than a specialist. The solutions to address these priorities are to:
- make information about purpose of prescription, side effects, standard dosage, and appropriate use for age group more available to workers and foster parents.
- assigning responsibility for approving medications to the local department worker not the foster parent.
- have a standard consent form for worker to pull information and fill out and include a checkbox as to whether birth parents and/or youth (over 12/14) were involved in the decision to medicate.
- recommend oversight process where worker approves and then someone else in the agency who has training to review consents and signs.
- to screen and treat trauma before considering a prescription for medications.
In addition to these recommendations, the state, as of June 1st, also must work on over-diagnosis of kids in care.
Operation Permanency – Court Improvement Program Joint Project
Operation Permanency is a joint project between Court Improvement Program(CIP) and VDSS to reduce barriers to achieving permanency. The focus of this project is on children who have been in foster care 24 months or longer, with parental rights terminated and no permanent placement has been identified. The project scope included needs assessment, selection interventions, develop operational supports, pilot project, and implementation assessment. As of April 1, 2018, 5294 children are in care. 417 of those children are in the project population – meaning they have no planned permanency. Updates on this population and project progress will be presented at future CWAC meetings.
VDSS shared an update on the first stage of replacing OASIS through the implementation of a mobile application known as COMPASS. This is the first time Virginia will have a tool that sends data and other case related information through the cloud, so security is a major issue. It will probably be early spring next year before we will start use it as a pilot program.