Analysis of L.A. County's Blue Ribbon Commission On Child Protection Report, Recommendations

Blue Ribbon Commission Final Report Feasibility Anal ysis
Table of Contents Final Report

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TableofContents

ExecutiveSummary.............................................................................................................................4
ReviewofBRCCPRecommendations....................................................................................................7
I. ArticulateaCountywideMissiontoPrioritizeandImproveChildSafety........................................7
II. EstablishanEntitytoOverseeoneUnifiedChildProtectionSystem............................................10
III. DefineMeasuresofSuccessandOverseetheReformProcess.....................................................16
IV. AdopttheCommissionsInterimReportRecommendations........................................................19
V. ResolvetheCurrentCaseManagementCrisis...............................................................................23
VI. RecommendationstoAddresstheOutofHomePlacementCrisis...............................................24
VII. RecommendationsNecessarytoSupporttheCountywideSafetySystem...................................29
A.ImproveSafety...........................................................................................................................29
B.ComprehensivePreventionSystem...........................................................................................31
C.TrainingandWorkforceDevelopment......................................................................................32
D.TechnologyandDataSharing....................................................................................................34
E.TransparencyandtheRelationshipwithProviderandtheCommunity....................................36
F.Education...................................................................................................................................37
G.MentalHealth............................................................................................................................39
VIII. EstablishanOversightTeamtoEnsureImplementationofRecommendations...........................44


Executi ve Summary Final Report

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ExecutiveSummary
InresponsetotheApril18motion,theChiefExecutiveOffice(CEO),DepartmentofChildrenand
FamilyServices(DCFS),andCountyCounsel(CoCo)reviewedthefinalreportissuedbytheBlue
RibbonCommissiononChildProtection(BRCCP)todeterminethefeasibilityandthecost
associatedwiththeimplementationoftherecommendations.TheBRCCPreporthadatotalof55
recommendationswithineightbroadcategories.TorespondtoyourBoardmotionandto
accuratelyconductafeasibilityofalltherecommendations,westructuredthereporttoaddress
theeightmajorrecommendations.
WefocusedourreportonwhattheBoardwouldneedtodoinordertoimplementthe
recommendations,highlightedanylegalchallengesandanyassociatedcosts.Ifweidentified
areaswherethereweresignificantimplementationcomplexities,weproposedthatasmallshort
termpilotbeconductedinordertodeterminethetruefeasibilityofacountywide
implementation.Thedepartmentswouldberequiredtodevelopaplanforthepilotwithclear
goals,measurableobjectives,policychanges,uniondiscussionorjobchangesrequiredalongwith
theassociatedcostofimplementation.Theoverallgoalwouldbethatifthepilotproves
successful,thentheCountywouldimplementtheprogramsand/orinitiativescountywide.
Finally,sinceLosAngelesCountyisaverycomplexorganizationanditwouldbeimpossiblefor
anexternalentitytobefullyawareofalltheprogramsand/orinitiativescurrentlyunderway;we
havetotheextentpossiblehighlightedexistinginitiativesthathaveeitherbeencompletedorare
inprogresswhichmayaddresssomeoftheBRCCPrecommendations.
Themainportionofthereportrespondstoeachoftheeightbroadrecommendationsas
highlightedintheBRCCPreport.However,theExecutiveSummaryprovidesaframeworkthat
yourBoardcouldusetohaveaninformeddiscussion.Tothatend,wehaveorganizedthe
recommendationsintothreecategories:1)Infrastructureand/orOrganizationalchanges;2)
Programand/orPolicychanges;and3)Dataand/orTechnology.
1. Infrastructureand/orOrganization(Recommendations1,2and8)These
recommendationsproposechangestotheCountyinfrastructureorwillrequirechangesin
organizationalresponsibilities.Withintheserecommendations,theBRCCPproposesthat
yourBoard,establish:
BRCCPRecommendations
1. AJointStrategicPlanningProcessthatwouldresultinacountywidemissiontoprioritize
andimprovechildsafety.
2. ASingleEntitytooverseeoneunifiedchildprotectionsystem
8.AnoversightteamtoensuretheimplementationofalltheBRCCPrecommendations.



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2. ProgramorPolicy(Recommendations4,6,7B,7C,7EG)Theserecommendations
proposethedevelopmentofnewinitiativesand/orredefinesexistingprograms.
3. EstablishICANasanIndependentEntity
4. ImplementtheCommissionsInterimReportRecommendations
4.1FullyimplementESCARS
4.2MedicalHubs
Medicallyscreenallchildren,underageone,whosecasesarebeinginvestigatedand
allchildrenenteringplacement
ChildrenplacedinoutofhomecareorservedbyDCFSintheirhomesshouldhave
ongoinghealthcareprovidedbyphysiciansatMedicalHubs
4.3PairaPublicHealthNurse(PHN)withDCFSSocialWorker,whenconductingChild
AbuseorNeglectinvestigationsforallchildrenunderageone.
4.4ConsolidatethePublicHealthNursesunderoneCountydepartment(Notincludedin
BRCCPreportbutrecommendedbyDCFS).
5. ResolveCaseManagementCrisis.ContinueoversightofDCFSstrategicplanbyaddinga
requirementforregularreportingofspecificsafetyrelatedoutcomes.Establishspecific
benchmarksforimprovementinmeasuresidentified.
6.RecommendationstoAddressOutofHomeCare
6.1KinshipCare
Fundingshouldbedeterminedbytheneedsofthechild,notwhetherplacementis
witharelativeorafosterfamily.
Conductareviewofthecurrentmixofcountylicensingandsupportsforfoster
homesandapprovalandsupportsforkin.
6.2RecruitmentofNonRelativeFosterHomes
Conductanindependentanalysisofnonrelativefosterfamilyrecruitmentefforts
Developacomputerized,realtimesystemtoidentifyavailableandappropriate
placementsbasedonthespecificneedsofthechild.
DCFStoinvolvefosteryouthintheratingandassessmentoffosterhomes.
7.RecommendationstoSupportCountywideSystem
7.bComprehensivePrevention
Developacomprehensivepreventionplantoreducechildabuseandneglect.
7.cTrainingandWorkforce
Developacrosstrainingmodelwithaninterdisciplinaryapproach.
Createaninnovative,open,andadaptivetrainingprocessforsocialworkers.
7.eTransparencyandRelationshipwithProvidersandCommunity
Greaterdisclosure,clarify,andinclusionofcommunityengagement.
7.fEducation
Establishmechanismsforcrosssystemeducationrelatedcoordination.
Increaseaccesstoearlyinterventionservicesforfosterchildrenandchildrenathigh
riskofabuseandneglect.
EnsureschoolstabilityandchildsafetyisimprovedthroughexpansionoftheGloria
MolinaFosterYouthEducationProgram.
7.gMentalHealth
Mandatenonpharmacologicalinterventionsasbestpracticewhereverfeasible.
Incorporatetraumafocusedassessment&treatmentforteens/transitioningyouth.
Ensurechildrenagefiveandunderinthechildwelfaresystemhaveaccesstoage
appropriatementalhealthservices.


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3.Dataand/orTechnology(Recommendations3,5,7A,and7D)ThreeBRCCP
recommendationsfocusondefiningmeasuresofsuccessaswellasimprovingaccess,
management,andreportingofdatatodrivedecisionmakingforthechildwelfaresystem.

3. RecommendationtoDefineMeasuresofSuccessandOverseetheReformProcess
Adoptclearoutcomemeasuresandensureaccountabilitybyregularassessmentofwhether
goalsarebeingattained.Assessmentsshouldmeasureoutcomes.
7.7.aImproveSafety
ImplementtheprocessusedbyEckerdinHillsboroughCounty,Floridatoachieve
remarkablesafetyresults.
7.dTechnologyandDataSharing
Developaclear,multisystemdatalinkageandsharingplanthatwouldoperateasa
single,coordinatedsystem.
CreateaCountywideconfidentialitypolicyregardingachildsrecordsandcourt
proceedingstoallowsharingofinformationandincreasetransparencyofthe
system.

Review of Recommendation I Countywide Mission

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JOINTSTRATEGICPLANNINGPROCESS

TheCountycouldcreateaninterdepartmentalteamwhichmaybenamedtheLACountyChild
WelfareCouncil(LACWC),comprisedofallrelevantdepartmentssuchas:
ChildrenServices HealthServices OtherDepts.

Children&FamilyServices
PublicSocialServices
Probation
PublicHealth
HealthServices
MentalHealth
ChiefExecutiveOffice
Membership
ThemembershipwillbecomprisedofDepartmentHeadsand/orChiefDeputies.TheCommittee
representativewillhavetheauthoritytomakemanagementdecisionsonbehalfofthe
department.Theseindividualswillbeheldaccountableforensuringthestrategicplaninitiatives
areimplementedasdesignedandaccordingtothetimeframehighlightedintheplan.The
Committeecanestablishworkgroupsonspecificinitiativesandeachworkgroupshouldhavean
ExecutiveSponsorwhowillprovideoversightandensuretheoverallgoalsandobjectivesaremet.
TheLACWCshouldinvitespecificdepartmentssuchasSheriff,CountyCounsel,District
Attorney,andAuditorControllertoparticipateandprovideinputonspecificinitiatives.
RolesandResponsibilities
1. DevelopmentoftheCountywideStrategicPlanTheBRCCPcallsforthedevelopmentof
twocountywideStrategicPlans.One,whichisChildCenteredandFamilyFocusedandthe
secondplanonChildMaltreatmentPrevention.TheLACWCcouldcreateoneCountywide
StrategicPlanthatnotonlyaddressestheneedsofservicestofamiliesandchildrenwhoarein
oursystem;butalsoincorporatespreventioneffortsthatwouldenablefamiliestogetthe
servicesandsupportsneededsothattheywillnotneedtoenterourchildwelfaresystem.
OncetheCountywideStrategicplanisdrafted,itisimportantthattheLACWCobtain
feedbackandinputfromamyriadofsocialservices,health,andchildwelfarestakeholders,
suchasthePresidingJuvenileJusticeJudge,First5LA,providerorganizations,parental
organizations,fosteryouth,etc.
I. Articulate a Countywide Mission to Prioritize and Improve Child Safety
The Board should mandate that child safety is a top priority. It should articulate a child-centered,
family focuses, County-wide Mission and call for:
1. All relevant County entities to work together with the Community.
2. Joint Strategic Planning and blended funding streams
3. Data Driven Program and Evaluations
4. A comprehensive service delivery system, including prevention programs that stop child maltreatments
before it starts; and
5. An annual overview of the state of the field of child welfare, presented to the Board by external
consultants and experts.
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InadditiontothedevelopmentoftheCountywideStrategicPlan,theLACWCwillneedto
ensurethe:
ImplementationoftheCountywideStrategicPlanSincethemembershipofthe
LACWCiscomprisedofallrelevantdepartmentheadsand/orkeyexecutives,itis
criticalthattheybeheldaccountablefortheimplementationofthecountywide
strategicplan.Toeffectivelytracktheprogressofimplementation,theywillneedto
developaprojectmanagementprocesswherebyonamonthlybasistheyareprovided
withastatusontheimplementationofstrategicobjectives.TheLACWCwould
addressanyimplementationchallengesthatmayarisebetweendepartmentsandserve
astheclearinghouseforanynewCountyinitiativeslaunched,toavoidduplicationof
efforts.
DevelopmentofAnnualGoalsandObjectivesWhileitisimportanttocreatea
strategicplan,itusuallytakesalongtimetoimplementthestrategiesoutlinedwithin
theplan.TheLACWCcouldestablishannualgoalsandobjectivesthatcanbeusedto
trackoverallprogress.
DevelopFundingRecommendationsTheabovementionedgoalsandobjectives
shouldbeusedtoprovidefundingrecommendationstoyourBoard.Inaddition,the
LACWCshouldidentifywaystoleverageexistingcountywidefunding.
EstablishKeyPerformanceIndicators(KPI)thatcanbeusedtoevaluatewhich
programsand/orinitiativesareyieldingtheintendedresultsandwhichneedtobe
restructuredand/oreliminated.Moreimportantly,itwillinformtheCountyexecutives
onwhetherthechildwelfaresystemasawholeisimproving.Ifthesekeyperformance
indicatorsareappropriatelyestablishedandclearlytracked,theCountywillbeableto
determinewhetherchildrenandfamilies,inoroutofourchildwelfaresystem,are
receivingtheappropriatesupportsandservices.
2. DevelopmentofaCountywideDataManagementSystemAnimportantcomponentto
monitoringKPIsishavingtimelyandaccuratedataavailable.Inresponseto
recommendationNo.3,weproposethecreationoftheChildWelfareDataManagement
System.ThisCommitteeshouldoverseethedevelopmentandimplementationofthissystem.
3. ReportingOnaquarterlybasis,theLACWCwilldevelopareport,tobediscussedwiththe
Boardthatprovidesastatusupdateontheimplementationofthestrategicplanalongwith
selectedperformanceindicatorsthataccuratelyindicateshowwelltheCountyisperforming.
InitiallytheLACWCwillneedtoestablishbaselinemeasuresandcleargoalsinorderto
determineareaswheretheCountyhasimprovedandareasthatstillneedattention.To
effectivelymanagedataandperformanceoutcomes,theCountywillneedtodevelopaData
ManagementSystemthatprovidesthedepartmentwithrelevantandtimelyinformation.
4. CommunityParticipation(Advisory)Itisimperativetoobtainstakeholderfeedbackon
theimplementationofmanyoftheseinitiatives.Tothatend,theCountycouldestablishan
AdvisoryCommitteeofchildwelfareexpertsthatcanprovideadviceonspecific
recommendationsand/orinitiatives.TheAdvisoryCommitteecanalsomonitortheCountys
overallprogresstowardstheimplementationoftheBoardapprovedBRCCP
recommendations.TheAdvisoryCommitteeshouldcomprisedofnomorethan5to7


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individualsandcanincludeindividualssuchasthePresidingJuvenileJusticeJudge,LACare,
AssociationofCommunityHumanServiceAgencies(ACHSA),UniversityConsortiumfor
ChildrenandFamilies(UCCF),CaliforniaEndowment,First5LA,CaseyFoundation,and
representativesfromtheCaliforniaDepartmentofSocialServicesorHealthServices.The
LACWCandAdvisoryCommitteecouldmeetquarterlyandberesponsibleforproviding
statusupdatesontheimplementationofthevariousinitiatives.
5. Independent Evaluation Every two years, the LACWC and Advisory committee could
bringinexpertstoevaluatevariouscomponentsofthechildwelfaresystem.Thiswillensure
that the Board has an independent review of how well the Strategic Plan is being
implementedandcanevaluatetheeffectivenessoftheprograms.
TheChiefExecutiveOfficecouldprovidetheleadershiprequiredtooverseeandcoordinateboth
theLACWCandAdvisoryCommittee.

ACTIONITEMSFORARTICULATINGACOUNTYWIDEMISSIONTOPRIORITIZEANDIMPROVE
CHILDSAFETY
1. EstablishtheinterdepartmentalLosAngelesChildWelfareCouncil(LACWC)responsiblefor
establishingaChildCenteredandFamilyFocusStrategicPlan.
2. EstablishanAdvisoryTeamresponsibleforprovidingexpertadvicetotheLACWCandoversee
theimplementationoftheCountywideStrategicPlan.


Review of Recommendation II Entity to Oversee One Unified Child Protection System

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II. Establish an Entity to Oversee One Unified Child Protection System

The Board should establish an entity, which could be called the Los Angeles County Office of Child
Protection (OCP), with County-wide authority to coordinate, plan, and implement one unified child
protection system. The director of the entity would report directly to the Board and be held
accountable for achieving agreed upon outcomes. The director must be vested with overall
responsibility for child protection in the County, and in part should:

1. Oversee a Joint Strategic Planning Process. In close collaboration with all relevant department heads
and community stakeholders, the director must lead a process to create a comprehensive, child-centered
strategic plan that is data driven, informed by best practices, connects all welfare services in the
County, and articulates measurable goals and time frames.
2. Have clear oversight and authority over financial and staffing resources from all relevant departments,
as delegated by the Board.
3. With regard to all resources related to child welfare, institute an annual County-wide budget review
process which examines all proposed, present and past resource allocations and aligns them with the
goals of the County-wide strategic plan. The director also should coordinate relevant funding streams
from various departments, explore strategic uses of Title IV-E and other flexible funding sources, and
allocate funding based on a shared County child welfare mission, strategic plan, annual goals and
measurable outcomes.
4. Review existing County commissions and all recommendations related to the protection of children.
Oversee implementation of appropriate proposals, as well as the streamlining of existing commissions.
5. Establish and evaluate measurable outcomes as part of the annual planning and budget allocation
process. Such a system would facilitate constant improvement, generalizing successful pilot programs
to the whole system and discontinuing unsatisfactory practices.
6. Oversee County-wide prevention efforts.

JOINTSTRATEGICPLANNINGPROCESS
InresponsetorecommendationoneArticulateaCountywideMissiontoPrioritizeandImprove
ChildSafety,weproposedthecreationoftheLACountyChildWelfareCouncil(LACWC).If
yourBoardcreatestheOfficeofChildProtection,theDirectorcouldserveastheChairand
provideleadershipanddirection.
OFFICEOFCHILDPROTECTION
ThissectionisbaseduponananalysisfromtheOfficeoftheCountyCounsel.IfyourBoard
wantedtocreatetheOfficeofChildProtectionwithCountywideauthoritytocoordinate,plan
andimplementoneunifiedprotectionsystem,ataminimum,yourBoardwouldneedtoenact
newCountyordinanceswhichcreatethenewOfficeofChildProtectionandsetforthitspowers
andduties.
1
SincetheOfficeofChildProtectionwouldneedtohaveCountywideauthorityto
coordinate,planandimplementoneunifiedchildprotectionsystem,itwouldappeartobea
Countydepartment,asopposedtoanadvisorybody.
InadditiontonewordinancesthatcreatetheOfficeofChildProtection,existingCounty
ordinanceswouldneedtobeamendedtolocatetheOfficeofChildProtectionatthe
recommendedpositionwithintheCountygovernancestructureandmakeitsdirectorreport
directlytotheBoardofSupervisors.TotheextenttheBoardmightwantexistingdepartmentsto
reporttotheOfficeofChildProtectionthatwouldalsorequirealterationstoCountyordinances.

1
Los Angeles County Charter, Article III, Section 11(4) states that it shall be the duty of the Board of Supervisors to provide, by
ordinance, for the creation of offices other than those required by the constitution and laws of the State, and for the appointment of
persons to fill the same, and to fix their compensation.


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TheBRCCPrecommendedthattheOfficeofChildProtectionhaveauthoritytocoordinate,plan
andimplementoneunifiedchildprotectionsystemandthatitsdirectorhaveclearoversightand
authorityoverfinancialandstaffingresourcesfromallrelevantcountydepartments.TheBRCCP
alsonotedthatDCFSisnotandcannotbeviewedassolelyresponsibleforallaspectsofchild
protectionbutthattheCounty'ssafetynetshouldinvolvemanyotherdepartmentsincludingthe
DepartmentofPublicHealth,MentalHealth,HealthServices,PublicSocialServicesand
Probation.TotheextenttheBoardmaywanttotransferresponsibilitiesfromdepartmentstoa
newlycreatedOfficeofChildProtection,afteridentifyingwhichresponsibilitiestheBoardmight
wanttotransfer,ananalysiswouldneedtobedonetodeterminewhetherexistinglawwould
permitthosedutiestobetransferredorwhetherlegislativechangewouldberequired.The
departmentsofChildrenandFamilyServices,PublicHealth,MentalHealth,PublicSocialServices
andProbationdischargedutiesunderStatelawandaretypicallysubjecttovaryingdegreesof
Stateoversight,allofwhichwouldneedtobecarefullyevaluatedinlightofanydutiestheBoard
wouldliketoreallocate.
TheLosAngelesCountyCodecurrentlyprovidesthattheDirectoroftheDepartmentofChildren
andFamilyServicesappointsallemployeesofthatdepartment.
2
IftheBoardofSupervisorswants
tocreatetheOfficeofChildProtectionandgiveittheauthoritytorecommendtotheDirectorof
theDepartmentofChildrenandFamilyServicesthenumberofstaffandthedifferentpositions
thatthedepartmentshouldhave,itcoulddoso.Ordinances,civilservicerulesandmemoranda
ofunderstandingwouldneedtobereviewedandlikelyamendedtoreflectthenewarrangement,
staffinglevels,etc.Undersuchanarrangement,theDirectoroftheDepartmentofChildrenand
FamilyServiceswouldremaintheappointingauthorityofDepartmentofChildrenandFamily
Servicesemployeesandwouldcontinuetomakepersonneldecisions.Undersuchascenario,the
OfficeofChildProtectionwouldmakerecommendations,buttheDirectoroftheDepartmentof
ChildrenandFamilyServices,astheappointingauthority,wouldultimatelydecidewhetherto
adoptthoserecommendationsornot.
IfsuchanarrangementdoesnotgivetheOfficeofChildProtectiontheclearoversightand
authorityoverstaffingresourcesenvisionedbytheBoardofSupervisors,analternativeapproach
wouldbetotransferpositionsfromtheDepartmentofChildrenandFamilyServicestotheOffice
ofChildProtectionandmaketheDirectoroftheOfficeofChildProtectiontheappointing
authorityoverthoseemployees.FortheOfficeofChildProtectiontohavethatlevelofauthority
overstaffingandemploymentissues,theCountyCodewouldneedtobeamendedsothat
appointmentofsomeorallemployeesismovedfromtheDirectoroftheDepartmentofChildren
andFamilyservicestotheOfficeofChildProtection.Otherordinances,civilservicerulesand
memorandaofunderstandingwouldneedtobereviewedandmodifiedtoeffectuatesucha
change.IntheeventsomeemployeesfailedtofindapositionwithintheOfficeofChild
Protection,orweresufficientlydispleasedwiththepositiontheyacquired,litigationcould
conceivablyarise.
Currently,itistheDirectoroftheDepartmentofChildrenandFamilyServiceswhodirectsthe
administrationofchildren'sprotectiveservices,includinginvestigationofallegationsofchild
abuseandneglectandprotectionofchildrenremainingintheirownhome,etc.
3
FortheOfficeof
ChildProtectiontohaveauthoritytoimplement,ratherthanbeanadvisorybody,oneunified

2
Los Angeles County Code 2.38.020.
3
Los Angeles County Code 2.38.040(b).


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childprotectionsystem,itwouldappeartonecessitatemovingthosefunctionsfromtheDirector
oftheDepartmentofChildrenandFamilyServicestotheOfficeofChildProtection.
ExistingStatelawrequiresa"countydirector"tobeappointedbytheboardofsupervisorsor
otheragencydesignatedbycountycharter.
4
That"countydirector"shallhave"fullcharge"ofthe
countydepartmentandresponsibilityforadministeringandenforcingtheprovisionsofthe
WelfareandInstitutionsCodepertainingtopublicsocialservicesundertheregulationsofthe
DepartmentofSocialServicesandtheStateDepartmentofHealthServices.
5
TheCountydirector
mustserveastheexecutiveandadministrativeofficerofthecountydepartment,establish
administrativeunitsasthedirectormaydeemnecessaryordesirablefortheproperandefficient
administrationofthecountydepartment,andemploysuchpersonnelasmaybeauthorized,
subjecttoapplicablestandards.
6
Thecountydirectormustperformsuchotherdutiesasmaybe
prescribedbylaw.
7
The"countydirector"isrequiredtoabidebyalllawfuldirectivesoftheState
DepartmentofSocialServicesandtheStateDepartmentofHealthServicestransmittedthrough
theboardofsupervisors.
8
Therefore,transferringresponsibilityfortheperformanceoflegally
requiredchildwelfareactivities,formationofadministrativeunits,staffingandemployment
issues,etc.,awayfromtheDirectoroftheDepartmentofChildrenandFamilyServicesandtothe
OfficeofChildProtectionwouldseemtonecessitatetheheadoftheOfficeofChildProtection
becomingthe"countydirector"forpurposesoftheCounty'schildwelfareprogram.Therefore,a
changeinexistinglawmaybenecessaryiftheCountywantedtodividetheresponsibilityofthe
directorbetweentheDCFSdirectorandtheOCPdirector.
TakingtheDepartmentofHealthServicesasanexample,theLosAngelesCountyCodegrantsthe
directorthesoleauthoritytoactinallmattersconcerningtheDepartmentofHealthServices;
thus,atransferofauthorityoverchildren'smedicalcarewouldrequirearevisionoftheCounty
ordinance.
9
However,Stateregulations,aswellasMedicare'sconditionsofparticipationwhich
governtheabilityofCountyhospitalstoreceiveMedicareandMedicaidfunds,requireasingle
administratoroverallhospitaloperations,andStatelawrequiresasinglegoverningbodywith
ultimateresponsibilityforhospitaloperations.
10
Thus,achangeinexistinglawwouldberequired
iftheCountywantedtodivideresponsibilityforchildren'sservicesinthehospitalinpatientand
outpatientdepartmentsfromresponsibilityforadults.
WithregardtotheDepartmentofMentalHealth,existingStatelawauthorizesthecountyboard
ofsupervisorstoestablisha"communitymentalhealthservice"tocovertheentireareaofthe
county.
11
Statelawfurtherrequiresthateachcommunitymentalhealthservicehaveamental
healthboardanditspecifiesitsduties.
12
Italsorequiresthatlocalmentalservicesbe
administeredbyalocalmentalhealthdirectorandspecifiesthepowersanddutiesofthemental
healthdirector.
13
Thedutiesofthementalhealthdirectorinclude:servingasthechiefexecutive
officerofthecommunitymentalhealthservice;exercisinggeneralsupervisionovermentalhealth
services;andrecommendingtothegoverningbody,afterconsultationwiththeadvisoryboard,

4
Welf. & Inst. Code 10801.
5
Welf. & Inst. Code 10802. For purposes of Division 9 of the Welfare and Institutions Code, which contains section 10802,
"Department" means the State Department of Social Services, as defined in Welfare and Institutions Code section 10054.
6
7
8
9
10
See 22 Cal. Code Regs. Sect. 70701 and 42 C.F.R 482.12.
11
12
Welf. & Inst. Code 5604.2.
13


Page 13
theprovisionofservices,establishmentoffacilities,contractingforservicesorfacilitiesandother
mattersasnecessaryordesirabletoachievethepurposeofthecommunitymentalhealth
services.
14
Chapter28.7oftheLosAngelesCountyCodeprovidesthattheDepartmentofMental
Healthshallbeunderthedirectionofthedirectorofmentalhealthandshalladministerall
mentalhealthservicesbytheCounty.
15
Toreallocatechildrelatedmentalhealthservicestothe
OfficeofChildProtectionwouldnecessitateachangeinexistinglawinsofarasthereallocation
wouldresultinthedirectoroftheDepartmentofMentalHealthnotexercisinggeneral
supervisionovermentalhealthservices,butrathersupervisingonlythatportionrelatedtoadults.
WhiletheOfficeofChildProtectioncouldbeinvestedwiththeauthoritytomakebudgetary
recommendationstotheBoardofSupervisors,givingitauthorityoverfinancialresources,as
recommendedbytheBRCCP,couldnecessitateachangeinexistinglaw.Forexample,itis
difficulttoseehowthedirectorofmentalhealthwouldhavegeneralsupervisionovermental
healthservices,asrequiredunderexistinglaw,ifthedirectordidnothaveauthorityoverfinancial
resourcesrelatingtomentalhealthservices.

Theseexamplesareintendedtoillustratehow,incertaininstances,Statelawmayneedtochange
inorderforsomechildrelatedservicestobereallocatedfromsomeCountydepartmentstoan
OfficeofChildProtection,butthisisnotintendedtobeanexhaustivelistofallsuchlaws.So,
creatinganOfficeofChildProtectionwouldinvolveidentifyingwhataspectsofchildprotection,
inthebroadsense,theBoardofSupervisorswouldwanttoreallocateandthenanalyzingthe
extenttowhichexistinglawmayneedtobechangedtosupportthatreallocation.
TotheextentthedutiesofthesevariousCountydepartmentscouldberedistributed,ordinances,
civilservicerules,andmemorandaofunderstandingwouldneedtobeamendedtoreallocate
thoseduties.SuchareallocationcouldimpactwhichCountydirectorsatisfiescertainduties
underexistinglaw,forexample,whethertheDirectoroftheOfficeofChildProtectionorthe
DirectorofDCFSisthe"countydirector"forpurposesoftheCounty'schildwelfareprogram.

14
15


Page 14
REVIEWOFEXISTINGCOMMISSIONS
TheBRCCPprovidedtheCEOwithalistof23Countycommissions,whotheybelievedwere
primarilyfocusedonchildwelfare.TheyproposedthattheBoardconsiderstreamliningthese
Commissions.Uponreview,thereareonlyfiveCountycommissionswhoseprimary
responsibilitiesarechildwelfareastheothercommissionshaveadifferentscopeandpurpose.
BelowpleasefindalistofthecommissionsthattheBRCCPsuggeststhattheCountystreamline.
Wehavecategorizedthosecommissionswiththefocusareas:childwelfare,health,social
services,andother.
TableA:CommissionswithChildWelfareFocus
CountyCommission Goal
1. AuditCommittee Oversees thefollowupandimplementationofauditrecommendations,
assistsinmediatingdisputesrelatingtoauditfindingsand
recommendations.
Suggestsareas/departmentsforGrandJury,andreviews/takesactionon
theCounty'sresponsetotheFinalReportoftheGrandJury.
2. Commissionfor
ChildrenandFamilies
Monitorsandreviewsprogramsandservicestochildrenandfamiliesat
risktoensureacomprehensive,coordinated,andwellintegrated
County/communityservicedeliverysystem.
Receivesinputfromcommunitygroupsandpresentationsfromline
departments,createsanddistributesbiannualreports,andmakes
recommendationsaboutchildrelatedlegislationandimprovementsto
departmentheadsandtheBoard.
3. InterAgencyCouncilon
ChildAbuseandNeglect
Improvesthelivesofabused,neglectedandatriskchildrenthrough
multidisciplinaryeffortsthatsupporttheidentification,preventionand
treatmentofchildabuseandneglect.
Providesadvocacyandleadershipforimprovedpolicydevelopment,
provisionofservices,publicawareness,educationandtraining.Child
DeathReviewTeam.
4. PolicyRoundtablefor
ChildCare
ServesastheofficialCountybodyonmattersrelatingtostrengthening
thechildcaresystemandinfrastructureintheCounty.
Providespolicyrecommendations,developstheregionalchildcareand
developmentmasterplan.
PromotesthecoordinationandintegrationofCountyrelatedand
developsrecommendationstopromoteuniversalaccesstochildcare
anddevelopmentservices.
5. SybilBrandCommissionfor
InstitutionalInspections
Visits andinspects eachjailorlockupinLosAngelesCounty,County
probationandcorrectionalfacilities,andtoyloanfacilitiesatleastonce
peryearorasdirectedbyajudgeoftheSuperiorCourt.Examinesevery
departmentofeachinstitutionvisitedandascertainsitsconditionasto
effectiveandeconomicaladministration,cleanliness,disciplineand
comfortofitsinmates,andinanyotherrespects.TheCommissionmay
alsoinspectgrouphomefacilities.

6.First5LA Focusesonincreasingthenumberofchildrenfromtheprenatalstage
throughage5whoarephysicallyandemotionallyhealthy,safe,and
readytolearn.
DevelopsaCountyStrategicPlanforthesupportandimprovementof
earlychildhooddevelopmentwithintheCounty.


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TableB:CountyCommissionsbyHealth,SocialServices,orOtherFocus
CountyCommission Goal
Health
1. BeachCitiesHealthDistrict PreventivehealthagencyservingtheSouthBaybeachcommunities.
2. CommissiononAlcohol&Drugs Focuses onalcoholanddrugissuestoreduceproblemsandnegative
impactofsubstanceusedisorders.
3. CommunityHealthCenterBoard Federallydesignatedqualifiedhealthcentertoobtainfederalhealth
carefunding.
4. DevelopmentalDisabilitiesBoard
(Area10LosAngeles)
Conductspublicinformationprograms,assistsindependentcitizen
advocacyorganizationsthatprovideservicestothosewithdisabilities
5. EmergencyMedicalServices
Commission
Focuses onpolicies,programs,andstandardsonemergencymedical
services.
6. HospitalsandHealthCareDelivery
Commission
ConsultsonpatientcarepoliciesandprogramsintheLosAngeles
Countyhospitalsystem.
7. L.A.CareHealthPlan ServeslowincomeindividualsinLA Countythroughhealthcoverage
programs.
8. LosAngelesCountyCommission
onDisabilities
Reviews arangeofissuesaffectingthelivesofpeoplewithdisabilities.
9. LosAngelesCountyMentalHealth
Commission
Reviewsandevaluatescommunitymentalhealthneeds,services,
facilities,andissues.
10. PublicHealthCommission AdvisesDirectorofPublicHealthonmattersofpublichealth.
SocialServices
1. CommissionforPublicSocial
Services
AdvisesDPSSonvariousmatters,includingfinancialassistanceand
socialservices.
2. CommissionforWomen Investigatescomplaintsofgenderdiscrimination,provides
recommendationsthatpromoteequalrightsandopportunities,
3. LosAngelesHomelessServices
Authority
TopreventandendhomelessnessinLA,conductstheHomelessCount,
providesvarioushousing/shelteroptionsandoutreach.
4. PersonalAssistanceServices
Council(PASC)
Improves InHomeSupportiveServicesbymaintainingproviderregistry
andreferralsystemforqualifiedserviceproviders.
Other
1. LosAngelesCountyBoardof
Education
EstablishespoliciesfortheLosAngelesCountyOfficeofEducation
(LACOE)andgovernsschoolsoperatedbyLACOE.
2. ParksandRecreationCommission AdvisestheBoard,theDirectorofParksandRecreationonacquisition,
improvements,andgovernmentofCountyparks,recreationalareas
andfacilities,andotherrelatedmatters.
3. ProbationCommission Inspectsjuvenilecampsandhallstoassurecompliancewithapplicable
lawsandregulations.

]

\
ACTIONITEMSFORENTITYTOOVERSEEONEUNIFIEDCHILDPROTECTIONSYSTEM
1. Establishanentitytooverseeoneunifiedchildprotectionsystem.
2. Streamlinechildwelfarecommissions.

Review of Recommendation III Define Measures of Success

Page 16
III. Define Measures of Success and Oversee the Reform Process

The Board should have a clear and consistent process of review. It should adopt clear outcome measures
and ensure accountability by regular assessment of whether goals are being attained. Assessments
should measure outcomes, such as the overall incidence of abuse; severe abuse, and neglect per capita by
a geographic area; the recurrence of maltreatment within six months; and the number of child fatalities
due to abuse or neglect. Other meaningful outcomes the County should assess relate to well-being.

1. The Board should adopt clear outcome measures which should include:
Overall incidence of abuse and neglect per capita by geographic area to be determined (e.g.
supervisorial district, zip code, SPA). This is a measure of both prevention and services.
Overall incidence of severe abuse and neglect per capita by geographic area to be determined.
Child fatalities are a low incidence subset of this group. Severe abuse and neglect is a better
barometer of overall child safety in Los Angeles County.
Recurrence of maltreatment within 6 months. This is a measure of the percentage of children
experiencing newly reported abuse or neglect within 6 months of a previous incident.
Number of child fatalities due to abuse and neglect. This is a critical measure of overall safety and
system performance, although it occurs too infrequent to be the only measure.
Other meaningful outcomes the County should assess related to well-being. These might include
access to services; engagements with juvenile justice; and graduation rates from high school and
college.
2. The Los Angeles County Office of Child Protection (referred to in Section II) should regularly assess
the Countys progress and report its findings directly to the Board. The findings should be reviewed
regularly at Board meetings.
3. ICAN should be removed from within DCFS and exist as an independent entity.

PERFORMANCEMEASURES
Weagreethatestablishingclearperformancemeasuresarekeytomanagingandimprovingour
servicedeliverysystemforchildrenandfamiliesandservestoenhanceouradministrative
infrastructure.Performancemeasuresareclearindicatorsfordeterminingwhichprogramsare
workingeffectivelyandwhichprogramsarenotyieldingtheintendedoutcomes.Moreover,
performancemeasuresarecriticaltolongtermstrategicplanning,decisionmakingandhelpto
establishfundingpriorities.
TheBoardofSupervisorsinDecemberof2012,throughmotionbySupervisorRidleyThomasand
SupervisorAntonovichwithanamendmentbySupervisorYaroslavsky,directedtheCEOin
consultationwithDCFS,DHS,DPH,ICAN,OfficeoftheCoronerandCountyCounseltocreatea
singleentityresponsibleforidentificationandreportingofkeychildwellnessindicators.
TheSingleEntityWorkgroupinventoriedtheexistingdatacollectedviathevarioussystems.It
reviewedexistingreportsbeinggeneratedtomeetfederalandstatemandatesandgeneralreports
usedtotrackprogramoutcomesforeitherspecificdepartmentsand/orinitiatives.Itwasevident
thattheCountycollectsasignificantamountofdatathroughamyriadofsystems.However,the
dataisnotcollectedorevenaggregatedinamannerthatwouldlenditselftobeusedtomake
informeddecisionsand/ordeveloplongtermstrategicgoals.Moreover,welearnedthatthereis
widespreadmisunderstandingamongstdepartmentsastowhatislegallypermissibletobeshared
betweendepartments.


Page 17
AlthoughtheworkoftheSingleEntitycommitteewasputonholdpendingthecompletionofthe
BlueRibbonCommissionreport,theworkgrouplearnedthat:
Itiscriticalthatpriortocollectingthedata,wedeterminethepurposeanduseofthedataso
thatthecorrectdataelementsarecollectedandappropriateparametersareestablished.
Understandinghowthedataisgoingtobeusedisvitalinensuringthattheappropriatedata
elementsarecollected.
Oneofthemajorobstaclesforcollectingsystemwidedatawasthelackofaconsistent
countywidetaxonomy.Forexample,DCFSandtheCoronerhavedifferentdefinitionsfor
modeofdeathwhichleadtochallengesinreportingdataandtrackingsystemwidetrends.
Itisimperativetodeterminebydataelementwhichdepartmentand/orsystemwillserveas
thesystemofrecord.Forexample,ifwehavethesamedatacollectedbytwodepartments,
butthedataisdifferent,howisthisinformationgoingtobereconciled?
Establishclearparametersforthefrequencyofthedatacollection.Notalldataisavailable
withinthesametimeframe.TheCommitteewillneedtodeterminewhichdataelementsare
appropriatetocollectmonthly,quarterlyand/orannually.
Establishaqualityassurancegroupthatvalidatestheaccuracyofthedata.
While none of these activities are insurmountable, they do require focused effort and resources
and there needs to be an individual responsible for leading this effort. The County, led by the
CEO, could create a Child Welfare Data Management System to generate the comprehensive
executivemanagementreportsthatcouldbeusedtomakemanagementdecisions,establishgoals
and funding priorities. The workgroup responsible for creating this Child Welfare Data
ManagementSystemwillbeaprojectundertheLACWCwhichwilloverseethedevelopmentand
implementation of the system. In 2007, the Board established the Healthier Communities,
Stronger Families, and Thriving Children (HST) to fund child welfare data technology projects.
Currently,thereis$6.7Minthisfund.
REGULARASSESSMENTONCOUNTYSPROGRESS
WeagreethatiftheCountyisgoingtoestablishacountywidestrategicplanforChildWelfare,we
alsoneedtoconcurrentlyestablishclearmeasurableoutcomes.Regularassessmentofthe
CountysoverallprogressoftheStrategicplancanbeaccomplishedinthefollowingmanner:
LACountyChildWelfareCouncilandAdvisoryCommitteeIfyourBoardapprovesthe
creationoftheLACountyChildWelfareCouncilalongwithanAdvisoryCommittee,the
infrastructurecouldbeestablishedtoensurethetimelyimplementationofthestrategicgoals,
reportingoftheoverallprogressandconductingquarterlyreviewofspecificchildwelfare
outcomes.
Atleastannuallytheentityresponsiblepublishesanannualreportontheoverallstatusofthe
implementationalongwiththeperformanceoutcomedata.



Page 18
INTERAGENCYCOUNCILOFCHILDABUSEANDNEGLECT(ICAN)
TheBRCCPcallsforICANtoberemovedfromwithinDCFSandexistasanindependententity.
ICANservesthreemajorfunctions
1. TheCountydesignatedICANasthelocalcouncilwhichestablishesthecriteriafor
determiningwhichentitiesreceivechildabuseandneglectpreventionandintervention
programfundingfromtheCounty'sChildren'sTrustFund.
16
IfICANbecameanindependent
entityfromtheCounty,theymightnotbeabletoservethisfunction.Werethatthecase,the
Boardwouldhavetodesignateanexistinglocalvoluntarycommission,boardorcouncilto
carryoutthesedutiesorelsethatportionofthetrustfundthatiscomprisedofrevenue
collectedfrombirthcertificatefees,whichhashistoricallybeenusedbytheCounty,would
passtotheState.
17
2. ICANservesasLACountysInteragencyChildDeathReviewteam.
18
Thestatutethatgivesa
countydiscretiontocreatesuchasagencydoesnotlimittheagencytoaparticularform.So,
anindependentICANcouldcontinuetoservethatfunction;although,itsdirectaccessto
confidentialjuvenilecaseinformationmaybehamperedifitisnotapartoftheCounty'schild
welfareagency.
3. PerCountyCode,anICANmemberisinvitedtoserveinanexofficioandadvisorycapacityto
theFirst5LACommission.
19
AnICANmembercouldcontinuetoserveontheFirst5
CommissionprovidedtheindependentICANisalocalorganizationforpreventionorearly
interventionforfamiliesatriskorhasthegoalofpromotingornurturingearlychildhood
development.
TheBoardcouldalsoconsidermovingICANundertheBoardsExecutiveOfficeand/orunderthe
ChiefExecutiveOfficerforoversight.IfyourBoardapprovesthis,wewillneedtoanalyzewhere,
withintheCounty,yourBoardwantstolocateICANanddraftordinancechangesnecessaryto
effectuatethatmove.

16
Welf.&Inst.Code18965.
17
Welf.&Inst.Code18968.5.
18
Pen.Code11174.32.
19
LosAngelesCountyCode3.72.050.

ACTIONITEMSFORDEFININGMEASURESOFSUCCESS
1.EstablishtheLosAngelesCountyChildWelfareDataManagementSystemtoaccuratelyreport
onthekeychildsafetyindicators.
2. DeterminewhetherICANwillbeanindependententity.


Review of Recommendation IV Interim Recommendations

Page 19
IV. Adopt the Commissions Interim Report Recommendations

The Commission recommends that the Interim Report and related recommendations be immediately
adopted to improve front-end decision-making. These included strengthening the responses of law
enforcement agencies and oversight by the District Attorneys Office; targeting more resources to
children age five and under who are at highest risk of abuse; and strategically utilizing health services.

OnFebruary4,2014,theBoarddirectedtheChiefExecutiveOfficer(CEO),withthecooperation
ofrelevantdepartmentsandCountyCounsel,toconductafeasibilityanalysisontheten
preliminaryrecommendationscontainedintheBRCInterimReport.InresponseonApril18,
2014,theCEOreportedonthefeasibilityandcosttoimplementeachofthepreliminaryBRC
recommendations.HighlightsoftheCEOsanalysisincludetheBRCsrecommendationsforlaw
enforcement,medicalhubs,andpublichealthnursesassummarizedbelow.TheBRCCPs
recommendationswhichhadimplementationconsiderationswereasfollows:
1.LAWENFORCEMENTESCARSshouldbeutilizedfullybyallrelevantagenciesandbewell
maintainedandenhanced.InordertoimplementthisrecommendationtheDAandDCFS
proposedthefollowing:
DistrictAttorney(DA)couldincreasestaffingformonitoringandoversightIfthe
Boardapproves,theDAcouldcreateanESCARsunittoreviewandauditESCARS
investigationsresultingintheprosecutionofchildabusescasesandconductregulartrainings
withintheDepartmentandtheCounty.Thecostoftheseadditionalpositionsis$467,000.
DCFScouldenhanceESCARSandcontinueongoingmaintenancesupportThe
preliminaryestimateforthesystemenhancementsandongoingESCARSsupportand
maintenanceis$764,000andincludesthehiringofoneormoreskilledprogrammerstomake
thenecessarycodingupdates;andoneseniorlevelsystemsanalysttoworkwiththe
programmersinoverseeingtheseupdates.
2.MEDICALHUBSTheMedicalHubimplementationwastwofold:
A.FrontEndDecisionMakingMedicallyscreenallchildren,underageone,whosecases
arebeinginvestigatedandallchildrenenteringplacement.
B.OngoingHealthCaretoEnsureContinuityofCareandCoordinationChildrenplacedin
outofhomecareorservedbyDCFSintheirhomesshouldhaveongoinghealthcare
providedbyphysiciansattheMedicalHubs.
A. MedicalScreeningsConductmedicalscreeningforallchildren,underageone,whoare
beinginvestigated,andallchildrenpriortoplacement.
Whiletherecommendationincludesallchildrenwhosecasesarebeinginvestigated,DCFSonly
hastheauthoritytoconductmedicalscreeningforchildrenwhoaretemporarilydetained.Forthe
purposesofthisresponse,thatistheperiod,typicallyaround72hours,betweenDCFSremovalof
achildfromthehomeoftheparentorguardianandthejuvenilecourtsissuanceofaremoval
order.Atissue,iswhetherornotDCFScanmakethedeterminationtochangethechilds


Page 20
coveragetoMediCalinallinstances.Bymedicalscreeningwemeanaminimallyinvasiveinitial
medical,dental,andmentalhealthscreening
20
.
Currently,childrenwhoaredetainedafterbusinesshoursandduringweekendsandholidays
awaittheirplacementattheChildWelcomeCenterorYouthWelcomeCenter,bothlocated
adjacenttotheLAC+USCMedicalHub,wheretheyreceiveminimallyinvasivemedicaland
mentalhealthscreeningspriortoplacement.Inaddition,perDCFSpolicy,withinthe30days
followingtheirplacement,newlydetainedchildrenalsoreceiveamoreextensiveinitialmedical
examatalocalMedicalHub,pursuanttocourtorder.
PilotFramework
SupervisorRidleyThomasApril22draftBoardmotioncalledforthecreationofapilotprojectin
SPAs6and8forallchildrenundertheageofonewhoaretemporarilydetainedtobeevaluatedat
theMedicalHub.
IfyourBoardapprovesthismotion,DCFSandDHSrecommendapilotattheDCFSCompton
RegionalOfficeandMLKJrMedicalHub.Thepilotwouldprovideallchildren(notjustchildren
underageone)withaminimallyinvasivemedicalscreeningpriortoplacement.TheCompton
RegionalOfficetemporarilydetainsabout40childrenpermonth.DHShasthestaffavailableand
canreadilyexpandtoincludeeveninghoursattheMLKJr.MedicalHubtoscreenallchildren
whoaretemporarilydetainedthroughouttheweekdayandearlyeveninghours.DHShas
committedtoensuringthatthesechildrenareseeninatimelymanner,sothatitdoesnotcausea
significantdelayingettingthesechildrenplaced.
DCFSrequiresastartupperiodtotrainsocialworkers,developprotocols,andreceiveformal
supportforthepilotfromtheunionsregardingtheexpansionofthesocialworkersduties.DCFS
willneedtodetermineadditionalstaffingneedstobecolocatedattheMLKHubduringthe
daytimeandearlyeveninghourstosupportCSWsinthevarioustasksassociatedwithmedical
screenings.Inaddition,DCFSwillensurethatchildrenareenrolledinMediCalFeeForService,
ifpossible,inordertodefraythecost.IftheBoardapproves,thedepartmentswilllaunchthe
pilotattheendofsummer2014.Oncethepilotprovessuccessfulandaprotocolhasbeen
established,theBoardmayconsiderexpandingthepilottootherDCFSRegionalOfficesand
MedicalHubserviceareas.
B.OngoingHealthCaretoEnsureContinuityofCareandCoordinationChildrenplaced
inoutofhomecareorservedbyDCFSintheirhomesshouldhaveongoinghealthcare
providedbyphysiciansattheMedicalHubs.

WhiletheBRCCPrecommendationincludesallchildren,DCFShastheauthoritytocoordinate
themedicalcareofaminoronlywhentheminorhasbeentakenintoprotectivecustody(out
ofhome).Toimplementthisrecommendation,DCFSandDHSareplanningapilottoenroll
childrenintotheDHSmedicalhomesattheMedicalHubs.DHSwouldleverageexisting
capacity,andtheywouldworkwithrelativecaregiversandgrouphomestodevelopaplansothat

20
The screening may include: a review of available health and developmental history, a standard review of systems, a
measurement of the childs height, weight, taking of vitals, a physical examination of the clothed child by a physician or
nurse to identify signs of acute and chronic illness, the completion of a standard screening tool to assess the childs
developmentalandmentalhealthneeds.


Page 21
childrenundertheircarehavearegularcontinuitymedicalprovider,physicianormidlevel
provider,whoworksaspartofamedicalhometeamtoprovidethesepatientsongoing
coordinatedhealthservices.Finally,DCFSandDHSwillneedto:1)determinewhetheradditional
resourcesarerequired,and2)developaprocessforensuringthatDHScostsarereimbursedfor
thosechildrenwhoarenoteligibleforMediCalFeeforService.Atissue,iswhetherornotDCFS
canlegallymakethedeterminationtochangethechildscoveragetoMediCalininstanceswhere
thefamilyhasexistingmedicalcoverage.
PilotFramework
Toimplementthisrecommendation,DCFSandDHSarerecommendingapilotattheMLKJr.
MedicalHubtoimprovethecontinuityofmedicalcareforchildreninnearbygrouphomes.
DCFSandDHSwouldpartnerwithgrouphomeprovidersintheMLKJr.MedicalHubservice
area(SPA6)sothattheirresidentsreceivethesecomprehensivemedicalservicesattheHub.
DHSwouldleverageexistingresourcesandworkwithgrouphomeproviderstodevelopaplanso
thatchildrenundertheircareareseenbyamedicalproviderasisrequiredtoadequatelyaddress
thehealthneedsofeachchild.Atthistime,thereare24grouphomeswithintheMLKMedical
Hubareawith156childrenplacedinthosefacilitiesbyDCFS.Currently,theDCFSOutofHome
CareManagementDivisionisintheprocessofcontactingeachGroupHomeprovidertosolicit
theirinterestinpilotingthisconcept.DCFSplanstoidentifygrouphomeprovidersinterestedin
voluntaryparticipationinthepilotbylatesummer2014.
Totrackoutcomesinimprovedcontinuityofcare,DCFSisexploringthedevelopmentofa
parallelapplicationthatwillinterfacewithDHSEmHubWebbasedsystem.Thisnew
applicationwillbeusedtotrackandalertthecasecarryingCSWsandtheGroupHomecare
providersoftheupcoming,periodicmedicalexamsandensurethatthereferralsand
appointmentsarecompletedtimely.Theestimatedcostforthisenhancementis$100,000.BIS
willusecurrentresources(FY20142015budget)tocreatetheGroupHomeMedicalexam
TrackingreportandestablishtheMedicalExamalertstoCSWsandSCSWs.Asanextstep,DHS,
DCFSandthegrouphomeswilldiscussanevaluationofthepilotsothatwecandemonstrate
measurablesuccess.
IfthepilotprovessuccessfulinimprovingwellbeingoutcomesforDCFSsupervisedGroupHome
residents,DHSwillidentifytheresourcesrequiredtoaddressthisneedonalargerscale.DCFS
willalsorecommendthatGroupHomecontractsbeamendedtoreflectthechange.Finally,DCFS
andDHSwillneedtodeterminewhetheradditionalresourcesarerequiredtodeveloptheparallel
applicationaswellasaprocessforensuringthatDHScostsarereimbursedforthosechildrenwho
arenoteligibleforMediCalFeeforService.
3.PUBLICHEALTHNURSESPairaPublicHealthNurse(PHN)withaDCFSSocialWorker,when
conductingChildAbuseorNeglectinvestigationsforallchildrenageoneandunder.
Currently,aPHNnurseaccompaniestheDCFSsocialworkerforallchildrenwhoseinvestigation
isrelatedtomedicaland/ordevelopmentalproblems.UnderthecurrentFosterCareNursing
Program,DCFSPHNsjointlyinvestigatereferredchildrenduringtheEmergencyResponsephase.
DCFSisproposingthatwepairaNurseandaCSWforchildrenfrombirthtoage23monthsold.
Incalendaryear2013,18,397childrenwithinthisagerangewerereferredtoDCFSforaninperson
investigation.Thisrepresentsanaverageof1,533childrenpermonth.


Page 22
Ofthe13,397referredchildren,frombirththroughage23monthsoldin2013:
1,370(7%)receivedajointCSW/PHNinvestigation;and17,027(93%)didnot.
Ofthe17,027childrenwhodidnotreceiveajointCSW/PHNinvestigation,
o 13,157(77%)weretraditionalbusinesshourinvestigations;and
o 3,870(23%)wereafterhoursandweekend/holidayinvestigations.
PilotFramework
Supervisor RidleyThomas April 22 draft Board motion called for the development of a pilot to
pair a PHN with a social worker in SPA 6. If your Board approves, DCFS proposes a pilot at the
DCFS Vermont Corridor Regional Office. DCFS would determine the total number of children
under age one who receive an investigation, assign social workers and nurses to conduct joint
investigations,anddevelopanewprotocolandtrainingcomponentforsocialworkersandnurses.
DCFS will need to add three additional PHNs to the Vermont Corridor office to allow for joint
PHN/CSW investigation on every referral with a child age one and under. This is based on the
increased workload from four visits per month to an estimated 93 visits per month. The seven
PHNs will support the six ER units in the Vermont Corridor office. The cost for four additional
PHNsandassociatedcostsisestimatedat$800,000.
DHSandDCFSproposethatpriortothedevelopmentofsuchaplan,theCounty:1)explorenurse
classificationstodeterminewhetheraPHNorNursePractitioner(NP)isbestsuitedto
accompanythesocialworkerfortheinvestigation;2)consultwithCountyCounseltodetermine
thedutiesthateachclassificationmaylegallyperform(i.e.,visualobservationorphysicalexamin
home);and3)understandtheinterdependencyofthescreeningandongoingcareprovidedatthe
MedicalHubstoensurenoduplicationofefforts.
ConsolidatingtheAdministrationofPublicHealthNursesAsstatedinourinterimreport,
theGovernors20142015BudgetrealignsfundingfortheHealthCareProgramforChildrenin
FosterCaretocountywelfareagencies.BeginningonJuly1,2015,thePHNprogramwillnolonger
befundedthroughCDSSandtheCaliforniaDepartmentofHealthCareServices,rather,funds
willbeallocatedtocountiesthroughtheLocalRevenueFundforthepurposeofmeetingstate
andfederalrequirements.Asaresult,newMemorandaofUnderstandingdefiningrespective
rolesandresponsibilitiesamongcountydepartmentsofpublichealthandchildwelfaremaybe
needed.Inpreparation,aproposaltoconsolidatethePHNProgramunderthe
administrationofoneCountydepartmentisrecommendedtoestablishthetypeofnursebest
suitedfortherequiredduties;andtoclearlydelineatethenursesrolesandresponsibilities,
performancemeasuresandoutcomes.
ACTIONITEMSBRCCPSINTERIMREPORT
1. DistrictAttorneytocreateanESCARSunittoreviewandauditESCARSInvestigations.
2. DCFSand/orISDtoenhanceESCARSSystemandprovideongoingmaintenance.
3. ImplementtheMedicalHubscreeningpilottoensurethatallchildrenunderageoneare
screenedbyaMedicalHub.
4. DCFSandDHStopilotongoinghealthcaretooutofhomechildrenwithintheMedicalHubs.
5. PairaDCFSSocialWorkerwithaNurse,whenconductingChildAbuseandNeglect
Investigationsforallchildrenfrombirthto23monthsold.
6. ConsolidatetheadministrativeauthorityofPHNsunderoneCountydepartmenttoensure
cleardelineationofrolesandincreaseperformancemeasuresandoutcomes.

Review of Recommendation VI Out-of-Home Placement Crisis

Page 23
V. Resolve the Current Case Management Crisis

1. The Board should continue its active oversight of DCFSs strategic plan by adding a requirement for
regular reporting of specific safety related outcomes, including recurrence of maltreatment within six
months of a previous incident, maltreatment of rates in out-of-home placement, and re-entry into care
within six months of a permanent placement.
2. The Board should require regular reporting on the frequency of missed monthly social worker visits,
the wait times for children in offices or at the Command Post needing placement, the length of time for
kin caregivers to be approved, and the number of foster homes recruited.
3. The Board shall establish specific benchmarks for improvement in the measures identified in one and
two above, as warranted. This should be done in collaboration with the CEO and DCFS.
DCFSSTRATEGICPLAN
OnJune11,2013,SupervisorsMolinaandSupervisorAntonovichfiledaBoardmotionthat
requiresDCFStoprovidemonthlyupdatestotheBoardontheimplementationstatusoftheir
StrategicPlan.IfyourBoardcreatestheLACWC,theycouldpresentonaquarterlybasisan
updateonthefollowing:
1. TheDCFSStrategicPlanandincorporatethechildwelfaredataoutcomesas
recommendedbytheBRCCP.Theoutcomemeasuresonchildsafetyandwellbeingcould
include:
Incidenceofabuseandneglectpercapita(region)
Incidenceofsevereabuseandneglectpercapita(region)
Recurrenceofmaltreatmentwithin6months
Numberofchildfatalitiesduetoabuseandneglect
DCFSisintheprocessofdeveloping,throughtheirSTATsprocess,aperformance
dashboard;whichwillidentifycriticalchildsafetymeasuresthatcanbeusedtoevaluate
whetherspecificinitiativesareworkingasdesignedandwhetherthesystemasawholeis
improving.DatafromthisperformancedashboardshouldbeusedtoprovideBoard
updates.
2. CountywideChildWelfareStrategicPlanTheLACWCcouldpresentannuallythe
StrategicPlanforyourBoardapproval.Thestrategicplanshouldhighlightspecific
initiatives,alongwithtimeframesandhighlighthowtheseinitiativescouldbefunded.The
Committeecouldprovidestatusupdatesonspecificinitiativesonaquarterlybasis.
ProvidingquarterlystatusupdatestotheBoard,canalsoserveasavehicleforproviding
informationtothegeneralpublic.

ACTIONITEMSFORCURRENTCASEMANAGEMENTCRISIS
1. TheLosAngelesChildWelfareCouncil(LACWC)wouldprovidequarterlyupdatestothe
BoardontheDCFSStrategicPlanandtheCountywideChildWelfareStrategicPlan.


Page 24
VI. Recommendations to Address the Out-of-Home Placement Crisis

A. Kinship Care
1. A childs funding should be determined by the needs of the child, not whether placement is
with a relative or a foster family. The CEO and DCFS should examine the Countys ability to
waive federal eligibility rules and its accompanying funding flexibility to strengthen support
for children in out-of-home care.
2. The County and DCFS should utilize its Title IV-E waiver dollars to ensure parity of funding
for children placed with kin to that of children placed in foster family settings.
3. A childs services should be based on the needs of the child, not whether placement is with a
relative or a foster family. The CEO and DCFS should ensure that relative caregivers are
more fully supported to address a range of possible needs.
4. The County, through the Auditor-Controller and the CEO, should review the current mix of
county licensing and supports for foster homes and approval and supports for kin, to assess
the inconsistent performance and resource allocations, and to determine whether a more
uniform streamlined system would be more effective. The Commission believes consideration
of contracting out this process is warranted.

KINSHIPSERVICEFUNDING
Weunderstandthatthatlackofcaregiversupportsignificantlycontributestocaregiverturnover,
resultinginanoverrelianceonshelterandotherinstitutionalcaresettings.Withthisturnover,
childrenbecomemorelikelytoexperienceplacementdisruptionsandlesslikelytoachievethe
desiredoutcomesofadoptionorguardianshipwithapermanentfamily.
Currently,56%ofallCaliforniafosterchildrenarenotfederallyeligible.Californiahaschosento
providestateonlyfostercarebenefits,ifanonfederallyeligiblechildisplacedinanonrelative
fosterhomeorgrouphome.Relativecaregiversfornonfederallyqualifiedchildren:
Donotreceivefostercarebenefits,unlessthechildisinfostercareandthepaymentismade
throughtheKinGAPProgram.
CanreceiveCalWORKSbenefits;however,CalWORKSprovideslessthanhalfofwhatthestate
determinedastheminimumamountnecessarytoprovideforafosterchildsneeds.
Arecompensatedatamonthlybenefitof$369inCalWORKSbenefits.Whereas,non
federallyqualifiedchildrenplacedwithanonrelativearecompensatedatamonthlyStateonly
fostercarebenefitof$820.
TherearecurrentlytwofundingproposalsunderconsiderationbytheStateLegislaturetoaddress
thisBlueRibbonCommissionrecommendation:
1. TheCountyWelfareDirectorsAssociationofCalifornia(CWDA)hasproposedan
appropriationof$13.5millioninStateGeneralFundsforFosterandKinshipCareRecruitment,
RetentionandSupportinordertofunddirectsupportoffosterchildrenplacedwithkin
caregiversandfosterparents,whichitstateswillincreasechildwellbeingthrough
participationinnormalizingactivitiesforyouthincare.CWDAstatesthatcurrentlythereis
atotalof$3.1millionavailablestatewideforkinandfostercaregiversupport.



Page 25
2. AcoalitionofCaliforniaorganizationshasproposedanappropriationof$30to$36millionin
StateGeneralFundsforEqualizingFosterCarePaymentsforChildrenPlacedwithRelative
Caregivers.Theadvocatescontendthat,attherootoftheinequityisCaliforniasrefusalto
providestateonlyfostercarebenefitstothoserelativescaringforchildrenwhodonotmeet
federaleligibilitystandards.Federaleligibilityisbaseduponanantiquatedfederalrulethat
reimbursesstatesforfostercarecostsonlyifthechildwasremovedfromahouseholdthat
metthe1996eligibilityrulesforthenowdefunctAidtoFamilieswithDependentChildren
(AFDC)program.Overtime,fewerandfewerchildrenmeetthiscriterion.
KINSHIPFAMILYRESOURCECENTER
DCFSisrecommendingthatLACountyestablishaKinshipResourceCenter,available24hoursa
day,sevendaysaweektoproviderelativecaregiversandNonRelatedExtendedFamilyMembers
(NREFMS)withintensiveservicesandresourcesforthefirst90daysofplacement;andtosupport
caregiverswithconcreteservicesatthetimeofinitialplacements.
TheCountycouldcontractoutfortheseResourceCenterswhichwillberesponsibletoassist
relativecaregiversatthetimeofinitiationplacementbyprovidingemergencyfinancialassistance,
childcare,preliminarymedicalandmentalhealthassessments,medicalandmentalhealth
linkage,andeducationallinkageandsupportservices.Inaddition,the24/7centerwouldprovide
basicnecessitiesfood,formula,clothing,careseats,bedsandbeddingforemergency
placements,andforshorttermperiods,basedonanassessmentoffamilyneedsasfunding
differentialsareexplored.GiventhevastgeographicexpanseofLosAngelesCounty,under
additionalconsiderationisaccesstotherecommended24/7centerbycaregiverswith
transportationchallenges;andtheneedtoestablishacentralizedcallcenterforthepurposeof
addressingtheneedsofcaregiverstelephonicallywheneverfeasible.
REVIEWOFCURRENTMIXOFCOUNTYLICENSING
ThelicensingoffosterhomesandFosterFamilyAgenciesisaStatefunction,performedbythe
CaliforniaDivisionofCommunityCareLicensing(CCLD)withintheCaliforniaDepartmentof
SocialServices.TheprocessofCCLDlicensingandDCFSfosterparentrecruitmentandapproval
occurconcurrently,requiringinterestedcaregiverstointeractwithbothentities
simultaneously.AsignificantlystrengthenedworkingrelationshipbetweenCCLDandtheDCFS
fostercarerecruitmentstaffwithinthelast12monthshasturnedthetideinthenumberof
availablefosterhomesin2014,finallyreversingyearsofdecline.
DCFSiscurrentlyintheprocessofidentifyingprivatefundingtoconducttheBRCCP
independentanalysisofnonrelativefosterfamilyrecruitmenteffortsintheCountytodetermine
howthesystemcanbemoreefficientandeffective.Someofthequestionsbeingconsideredfor
analysisare:whetherthecurrentdualsystemofDCFSrecruitingstatelicensedhomesandFFA
certifiedhomesshouldbecontinued;acostcomparisonofeacheffort;andevaluationof
childrensoutcomesinstatelicensedvs.FFAcertifiedhomes;andrecommendationstobetter
coordinatepublicandprivaterecruitmentefforts.Inaddition,weneedtoleveragetheAuditor
ControllerandDCFSContractmonitoringprocesstoaddressinconsistencyinperformance
throughoutthefostercaresystem.


Page 26

B. Recruitment of Non-relative Foster Homes
1. The Board should call for an independent analysis of non-relative foster family recruitment
efforts in the County to determine how the system can be more efficient and effective. The
analysis should use sound data to address a range of questions, including whether there are
safe and appropriate homes in each SPA to meet the needs of foster youth.
2. DCFS should develop a computerized, real-time system to identify available and appropriate
placements based on the specific needs of the child.
3. DCFS should involve foster youth in the rating and assessment of foster homes.

INDEPENDENTANALYSIS
Withinthelastsevenyears,from2007to2013,LosAngelesCountyexperiencedadramatic
reductioninavailablefosterhomes.Thechartbelowdepictsthereductionofavailablehomes.
*BasedonMarch2014ChildWelfareServicesFactSheetData
**NumberofChildreninStateLicensedandFFAcertifiedoutofhomeplacements,excludingkinshipandNREFM
placements.
***Statelicensed/DCFSRecruitedFosterandSmallFamilyHomes,excludingthoseonhold.
****FosterFamilyAgencycertifiedHomesbaseduponselfreportsbythecertifyingagencies.
Thereductioninfosterhomesovertheyearsisattributabletoamyriadoffactors,suchas:aging
caregivers;theimplementationofuniversalassessment(akadualcertification);theincreased
coststosupportinfantsandteenscomparedtothefostercareratesetbytheState;andinternal
datareconciliations.Itisnoteworthytomentionthatthedataaboverepresentshomesandnot
beds.Althoughahomemaybelicensedorcertifiedforvariousnumberofbeds,oftentimesthe
typesofchildrenplacedinthesehomesimpactourabilitytoutilizethefulllicensedorcertified
bedcapacity.
Withinthesameperiodoftime,thechildwelfarecaseloaddroppedfrom37,735to36,766
between200714;thiswasprimarilyduetotheimplementationofnewTitleIVEservice
innovationsfocusedofkeepingchildrensafelyintheirbirthhomesorshortenedtimelinesto
permanency.However,welearnedthatchildrenremaininginoutofhomecareorcominginto
carehaveuniquephysical,developmentalandmentalhealthchallengescreatingtheneedfor
strategicandtargetedfostercarerecruitment.Itisnolongeronlyaboutthenumberofhomes,
butalsoaboutthetypesofhomes.
DCFSiscurrentlyintheprocessofidentifyingprivatefundingtoconducttherecommended
independentanalysisofnonrelativefosterfamilyrecruitmenteffortsintheCountytodetermine
howthesystemcanbemoreefficientandeffective.Someofthequestionsbeingconsideredfor
theanalysisare:whetherthecurrentdualsystemofDCFSrecruitingstatelicensedhomesand
FFAscertifiedhomesshouldbecontinued;acostcomparisonofeacheffort;anevaluationof
childrensoutcomesininstatelicensedvs.FFAcertifiedhomes;ananalysisofadditionalcosts
2007 2008 2009 2010 2011 2012 2013 2014*
ChildreninOutofHomeCare** 9,431 8,641 8,019 8,112 7,705 7,299 8,105 8,464
LicensedFosterHomes*** 2,108 1,566 1,228 1,031 935 513 534 580
LicensedSmallFamilyHomes*** 109 105 87 77 71 64 59 58
FFACertifiedHomes**** 4,479 4,420 4,977 4,021 3,169 3,027 2,941 2,986
TOTAL 6,696 6,091 6,292 5,129 4,175 3,604 3,534 3,624


Page 27
necessaryfortheCountytoenhanceitssupportofstatelicensedfosterhomes;and
recommendationstobettercoordinatepublicandprivaterecruitmentefforts.DCFScanreport
additionalprogressontheevaluationuponBoardsupporttoimplementtheBlueRibbon
Commissionrecommendation.
COMPUTERIZEDREALTIMESYSTEM
Developedin2002,theFosterCareSearchEngine(FCSE)isawebbasedapplicationthatprovides
theabilitytosearchforvacantbedsinLicensedFosterFamilyHomes,GroupHomesandFoster
FamilyAgencycertifiedHomes.TheFCSEextractsinformationfromthestatewideChildWelfare
Services/CaseManagementSystem(CWS/CMS)andinterfaceswiththeFosterFamilyAgency
VacancywebsitetoelectronicallyincorporatevacancystatuseswithinFosterFamilyAgency
certifiedhomes.TheFCSEincludesplacementhomesearchcriteria,i.e.,city,zipcode,agerange,
gender,ethnicity,language,religion,schoolboundary,thechildpopulationlicensedtobeserved,
andhometype.TheFCSEalsoprovidesaplacementhomeprofilethatincludeslicensing
information,placementhomecharacteristicsandbedoccupancydetails.
InanefforttoenhancethecurrentFCSE,theDepartmentrecentlyenteredasignificantamount
ofdatacorrectionstotheabovementionedinformationinCWS/CMS;andworkedwith
contractedFosterFamilyAgenciestoensurecontinuousuploadsoftheirnewvacancy
informationintotheFosterFamilyAgencyVacancywebsite.Asaresult,statelicensedFoster
FamilyAgenciescanelectronicallyentervacancyinformationintotheFCSEwebsitetoshow
availablebeds.Furthermore,thedepartmentisworkingtoensurethatstaffentersplacementand
replacementdataaswellaschangestoinformationaboutlicensedfacilitiesintotheFCSEina
timelymanner.
HavingfoundtheFCSEincapableofprovidingrealtimevacancyinformationduetoitsoutdated
GeographicInformationSystemcapabilitiesandInternetMappingServicetechnologies,the
departmentsubmittedanAdvancePlanningDocument(APD)totheStateseekingapprovalto
developanewFosterCareSearchEnginewithadvancetechnology.OnAugust21,2012,theState
approvedtheAPDrequest.
DCFSisscheduledtomeetwiththeUnioninlateMaytoreviewthepilotreportsandgetapproval
toimplementthesystem.AssumingthattheUnionapprovesthesystem,DCFSplansto
implementtherolloutplanbyJuly1,2014.
Becapableofmakingplacementreservations(holdavacantbedinahome,pending
placement);
Beequippedwithanenhancedgeographicinformationsystem;searchfilters;andaplacement
homemessageboard(providingdepartmentalstaffwiththeabilitytorecordcommentsand
vacancystatusdetails);
Enablecareproviderresourcemanagement(onlinerealtimeupdatesofhomeprofileand
bedutilizationinFosterFamilyHomes,SmallFamilyHomes,FosterFamilyAgencycertified
HomesandGroupHomes);
Enablecareprovideronlinereportingofcompletedmandatorytraining;and
TrackPlacementHomeEvaluations.


Page 28
INCLUSIONOFFOSTERCAREYOUTHINTHERATINGSYSTEM
Inordertoobtainfeedbackfromexistingfosteryouthwithinoursystem,DCFScoulddevelopa
surveythatwillbegiventofosteryouthattwoimportantintervals.First,everytimeayouthexists
oristransfertoadifferentgrouphomeorfosterfamily,wewillobtaininformationastowhythe
youthiseitherrequestingorwhythefostercareparentorproviderisaskingforthetransferofthe
youth.Second,duringthefinalTransitionMDTmeeting,priortotheyouthexitingthesystem,a
surveywillalsobeprovided

ACTIONITEMSFOROUTOFHOMECARE

1. TrackthetwostatefundingproposalssendtothelegislaturebyCWDAandother
coalitions.
2. DCFStoestablishapublicallyprivatelyfundedKinshipResourceCenter.
3. DCFStosecurefundingtoconductanindependentanalysisofnonrelativefosterfamily
recruitmentefforts.
4. DCFStofinalizetheimplementationoftheFosterCareSearchEngine.
5. FosterCareYouthInclusionintoRatingSystem.


Review of Recommendation VII A Improve Safety

Page 29
VII. Recommendations Necessary to Support the Countywide System

To create a Countywide, interdepartmental service delivery system, the Commission presents
recommendations for a system with the full array of services needed for prevention and treatment
of child abuse and neglect.

A. Improve Safety - The Board should direct the CEO to immediately implement the process used by
Eckerd in Hillsborough County, Florida and in other industries to achieve remarkable safety results.
The following components of this process are minimally required:
1. Conduct a review of all child fatalities due to abuse and neglect within the past three years of children
served in a Department of Health Services medical hub, DCFS, Probation, the Department of Social
Services (DPSS), by a DPH public health nurse or home visiting program or by a First 5 LA home
visiting program.
2. Conduct a thorough review of all open cases in the above departments.
3. Research review findings from Emily Putnam Hornstein, Ph.D and others on risk factors for Los
Angeles County children at risk for later child fatality due to abuse and neglect as well as data from the
Interagency Council on Child Abuse and Neglect.
4. Using both case reviews and research findings, identify specific characteristics that distinguish children
who have positive outcomes versus those who are subsequently severely injured or killed. Specifically
identify key risk factors that are present in cases resulting in child fatalities.
5. Equipped with specific case information and research findings that identify children at greater risk,
proactively engaged staff in the above serving departments to address risk factors immediately, thereby
mitigating the likelihood of a child fatality.
6. Utilize a technological solution such as E-SCARS that crosses departments to ensure that information
is shared and staff alerted when potentially fatal risk factors are present.
7. Continually measure progress against measures of success identified in Section III.
8. Modify access to and delivery of key services including; health, mental health; domestic violence;
substance abuse treatment; housing for adults; home visiting and prevention supports for children,
youth and families. These services will need to be prioritized for those at highest risk of later fatalities.

EckerdisaprocessconductedinHillsboroughFloridadesignedtoprovideanindependentRapid
SafetyreviewofalltheexistingchildwelfarecasesoverseeninFlorida.Theprocesswas
establishedtoconductspecificreviewssuchasallchildfatalitiesduetoabuseandneglect(within
thepastthreeyears)andreviewofallopencaseswithinDCFS.Thesereviewsshouldidentify
specificsafetymeasuresandspecificcharacteristicsofcaseswhichmayresultinchildfatalities.
Inaddition,itshouldalsohelptoidentifysystemicissuesacrossdepartmentssuchasHealthand
MentalHealth,whereservicedeliverycouldbeenhancedtoimprovetheendtoendcontinuum
ofservices.
Currently,therearenumerousentitieswithinLACountywhoconductchilddeathreviews:
DCFSRiskManagementDivisionreviewsandanalyzesdeathinallcaseswherethechild
and/orfamilyhadpriororcurrentDCFSinvolvement.DCFSalsomaintainsawebbased
CriticalIncidentFatalityTrackingSystem(CIFT),designedtotrackandmaintain
comprehensiveandpertinentdataelementsneededtoreportchildfatalities,critical
incidents,nearfatalitiesandSB39relateddeathsresultingfromchildabuseandneglect.
InteragencyCouncilonChildAbuseandNeglectservesastheLACountysInteragency
ChildDeathReviewteam.
ChildrenSpecialInvestigationUnit(CSIU)performstwofunctions.First,attherequestof
yourBoard,theyconductanindepthanalysisofspecificchilddeathandreportbackon
generalfindings.Inaddition,theyareresponsibleforidentifyingsystemicissuesthatcut
acrossdepartmentsandproviderecommendationsforBoardconsiderations.


Page 30
Inaddition,DCFSiscurrentlyintheprocessofpilotingaprojectentitledApproachto
UnderstandingRiskAssessment(AURA),atechnologicaltooldesignedtoperformdataanalytics
withthegoalofidentifying,withintheexistingcaseload,potentialcaseswhicharedeemedhigh
risk.UndertheEckerdsystem,thosecasesidentifiedashighriskwouldreceiveimmediate
attentionandserviceswithacomprehensivequarterlyreviewuntiltheyoungestchildinthecase
turnsthreeyearsofage.
TheBRCCPcallsfortheCEOtoimplementtheEckerdmodel.IftheBoardapprovesthis
recommendation,theCEOcouldworkwiththeDCFSRiskManagementTeam,DMH,DHSand
theCSIUtoidentifythoseriskfactorsthatwouldbeusedinfilereviews.Theprocesscould
includeallpertinentdepartmentswhoareresponsibleforprovidingservicestochildrenand
familiesunderthecareofDCFS.

ACTIONITEMSTOIMPROVESAFETY

1. ImplementtheEckerdmodeltoidentifyspecificcharacteristicsofcaseswhichmayresult
inchildfatalities.



Page 31
B. Comprehensive Prevention - The Board shall direct DPH and First 5 LA to jointly develop a
comprehensive prevention plan to reduce the overall incidence of child abuse and neglect.
COMPREHENSIVEPREVENTION
TheCountyDCFS,DMH,DPH,andCDC,andFirst5LAarepilotinganumberofeffectivemulti
agencypreventioneffortswithincommunitiestocreateasafetynetandtostrengthenfamilies
withchildrenagesbirthtofive.Someofthesepilotedeffortsinclude:
DCFSPreventionInitiativeDemonstrationProject(PIDP):DCFSandcommunity
agenciessuccessfullycollaboratedtosupportfamiliesatriskforchildmaltreatment.
First5LAsWelcomeBabyProject:InconnectionwiththePlacebasedBestStartInitiative,
thisvoluntaryhomevisitationprograminitiatescontactandengagementathospitalswhere
childrenarebornandsupportsthenewbornsfamilyforayearfollowingtheinfants
birth.Additionally,First5LAhassixotherintensiveinhomevisitationmodelstobenefit
familiesinareassuchasfeedingandparentbondingbeyondthoseofferedbyWelcomeBaby.
First5LAsBestStartInitiative:isbeingimplementedbaseduponasixcorefamilyvalue
frameworkwiththegoalofstrengtheningfamiliesandtheircommunitysupportnetworks.
DMHsMHSAfundedEvidenceBasedPreventionPrograms:
(a) ReflectiveParentingPrograma10weekparentingtrainingthatfocusesontemperament,
separation,security,discipline,angerandplayingwithoneschildren.
(b) ChildParentPsychotherapya50weekinterventionforchildren,agesbirthtofive,who
haveexperiencedatleastonetraumaticevent.Thegoalsaretorestorethechildssenseof
safetybyinvolvingtheparentintheintervention.
(c) ParentChildInteractiveTherapyan8monthinterventioninwhichatherapistobserves
theparent/childinteractthroughaonewaymirror;andcoachestheparenttomake
coursecorrections,practicerelationshipenhancementanddevelopdisciplineskills.
(d) IncredibleYearsParentingtotreatachildsaggressivebehaviorproblemsandAttention
DeficitDisorder.
TheCommunityDevelopmentCommissionsandtheHousingAuthorityoftheCounty
ofLosAngelesEmergencyandPermanentHousingPrograms:connectfamilieswith
affordablehousingthroughavarietyofsourcesincludingDMH,DCFS,First5LAandothers.
AshighlightedinrecommendationNo.1,theLACWCcouldberesponsiblefordevelopinga
CountywideChildWelfareStrategicPlanthatincorporatesandsupportseffortsforchild
maltreatmentprevention.
ACTIONITEMSFORCOMPREHENSIVEPREVENTION
1. IncorporatepreventioneffortsintotheCountywideChildWelfareStrategicPlan.

Review of Recommendation VII C Training and Workforce Development

Page 32
C. Training and Workforce Development

1. Departments and agencies closely involved in the identification, prevention, protection, and
treatment of at-risk children should be mandated to participate in cross-training with DCFS
employees. At a minimum, this interdisciplinary approach should include law enforcement, DMH,
DHS, DPH, the Dependency Court, and Probation. Entities that could help create appropriate
cross-training models include: UCCF, DA, and ICAN.
2. DCFS, DMH, and DHS should train personnel, both in-house and in contract agencies, on how to
most effectively work with the age 0-5 population, their families, and caretakers.
3. The UCCF should submit an annual report on outcomes that are aligned with the Countys vision.
4. DCFS should create an innovative, open, and adaptive training process for social workers and their
supervisors that consist of a continuous learning environment with training and research, akin to a
teaching hospital. It should also conduct a job audit of social workers to determine what can be
done differently or by others to address social worker workload.
INTERDISCIPLINARYAPPROACH
DCFScontinuestoworkcollaborativelywithanumberofotherDepartmentsandagenciesinthe
developmentanddeliveryoftrainingaroundchildprotectionservicestoourstaff,including
CountyCounsel,lawenforcement,DMH,ProbationandDPH.TheDepartmentiscurrently
workingwithUCLAandtheotherUniversityConsortiumforChildrenandFamilies(UCCF)to
developtheDCFSUniversity.TheDCFSUniversitysstrategicfocuswillincludeadirectiveto
increaseinterprofessionalworkforcedevelopmentandcollaboration.Thiswillincludethe
expansionofthemultidisciplinarytrainingeffortstoincludeandpromotecrosstrainingwith
CountyDepartmentsandotheragenciesinvolvedintheidentification,prevention,protectionand
treatmentofatriskchildren.CrosstrainingmodelwillbecentraltotheDCFSUniversity.
TheworkoftheDCFSUniversitywillprimarilybeTitleIVEfunded.Withthisfunding,andin
partnershipwithothercrosstrainingeffortsfunded,developedandconductedbyourCounty
partners(e.g.,Probation,DMH,DPH),DCFSisabletoimplementthisrecommendation.
Whilethecommunitycannotbemandatedtoattendtraining,itshouldbenotedthattheDCFS
TrainingSectioncurrentlyprovidestrainingontheidentificationofchildabuseandneglect,child
abusereportinglawsandDCFS101tovariousagenciesandgroups,asrequested,throughoutthe
County.
UNIVERSITYCONSORTIUMFORCHILDRENANDFAMILIES(UCCF)ANNUALREPORTONOUTCOMES
WeconcurthatUCCFshouldsubmitanannualreportonoutcomesthatarealignedwiththe
Countysvision.Inaddition,theyshouldreportquarterlyontheoverallstatusofimplementation
andtheiroverallperformanceoutcomestoeithertheOfficeofChildProtectionortheLACounty
ChildWelfareCouncil.
ADAPTIVETRAININGPROCESSFORSOCIALWORKERSTEACHINGHOSPITALMODEL
Incollaborationwithouruniversitypartners,DCFShasreengineeredthewayittrainsitsnewly
hiredCSWs,andhasalreadyestablishedateachinghospitalmodelwithcontinuouslearningfor
itsredesignedCSWfoundationaltraining.

Review of Recommendation VII C Training and Workforce Development

Page 33
The52weekCSWfoundationaltrainingconsistsofthefollowingthreephases:
InternshipPhase(Weeks13):Classroomandsimulationtrainingiscombinedwithfield
training,includingshadowingexperiencedCSWsandworkingwithCSWmentors,and
secondarycaseassignment.
ResidencyPhase(Weeks410):CSWscontinuewithablendofclassroom/simulationand
fieldtrainingandassumeprimarycaseloadassignmentsonagradualbasis.
ProfessionalEnhancement&AdvancedDevelopmentPhases(Weeks1152):CSWs
returntotheclassroomforadditionaldidacticandexperientialtrainingexperiences.
AspartoftheDCFSUniversity,theDepartmentalsoexpectstodevelopsimilartrainingand
createacontinuouslearningenvironmentforSCSWs,providingbasic,intermediateandadvanced
coursesandexperiencesthatbuildononeanotherandpreparemanagerstosuperviseand
supporttheirstaff.
TheDepartmentscontractwithUCLArequiresthatUCLAassessperformanceoutcomes,
includinglongertermimpactsoftrainingprovided,andidentifiesdatacollectionmethodsfor
thiseffort.Thecontractormayalsoseekapprovalforadditionalresearchprojectsthatexamine
howtrainingandstaffdevelopmentactivitiescontributetoorganizationandsystemslevel
changesovertime.Finally,asacknowledgmentofthenecessityofcontinuallyadvancingtheway
ourstaffandpartnersaretrained,theneedtoestablishatruelearningenvironment,andthe
impactofoureffortsonourchildrenandfamilies,DCFSandtheUCCFestablishedthe
AssessmentandAccountabilityCommittee.ThisCommittee,comprisedofuniversityandDCFS
representatives,ischargedwithoversightofbroaderimplicationsofourtrainingandresearch
efforts.

ACTIONITEMSFORTRAININGANDWORKFORCEDEVELOPMENT

1. DeveloptheDCFSUniversity,includingcrosstrainingamongdepartments,andthe
teachinghospitalmodeltooffercontinuouslearningforSCSWs/CSWs.
2. WorkwiththeUCCFtodevelopanannualreportonoutcomes.


Review of Recommendation VII D Technology and Data Sharing

Page 34

MULTISYSTEMDATALINKAGEANDSHARINGPLAN&CONFIDENTIALITY

InresponsetorecommendationNo.3DefineMeasuresofSuccessandOutcomes,we
highlightedthatBoardofSupervisorsinDecemberof2012,throughmotionbySupervisorRidley
ThomasandSupervisorAntonovichwithanamendmentbySupervisorYaroslavsky,directedthe
CEOinconsultationwithDCFS,DHS,DPH,ICAN,OfficeoftheCoronerandCountyCounsel
calledforthecreationofasingleentityresponsibleforidentificationandreportingofkeychild
wellnessindicators.NowthattheBRCCPhasissueditsfinalreport,theworkgroupshould
continuetomeettodevelopasystemresponsivetothatmotion.
Inaddition,therearesomepromisingeffortsemergingattheStatelevelthatappeartobeleading
towardsthedevelopmentofmoreinterconnectedsystemsatboththeStateandCountylevels.
OneexampleofthisistheCaliforniaHealthandHumanServicesInteroperabilityPlan,adraft
roadmapforsharingdataacrosshealthandhumanserviceagencies.Whilethisplanlistsseveral
actionstotakeplaceoverthenexttwoyears,theCaliforniaOfficeofSystemsIntegrationis
encouragingjurisdictionstotakeactionsearlierthatmovetowardsgreaterinteroperability.
TheSingleEntityworkgroupunderstandsthatanyplantosharedataelectronicallyneedsto
ensurethat:
1) Onlytheindividuals/entitiesthatarelegallyallowedtousethisinformationwouldhave
accesstoitsuchthatallconfidentialitylawsarefollowed;
2) Anysystem/portalthatisdevelopedisdonesoincompliancewithallelectronicrecordsand
sharingrulesincludingtheStatewideAutomatedChildWelfareInformationSystem
(SACWIS)regulations,andmayrequirepermissionfromtheState;and
3) Anysystem/portalcreatedwouldlikelybeatemporarysystemuntiltheStatesnewChild
WelfareServices/CaseManagementSystem(CWS/CMS)isimplemented.Theproposednew
systemwilllikelyincludemuchofthedatasharingthatcountiesareinterestedin,and,in
accordancewithSACWIS,wouldneedtoserveasthemainsystemofrecord.
InresponsetotherecommendationthatCEOandtheJuvenileCourtshouldcoleadthecreation
ofaCountywidepolicyoninformationsharing,Californiastatelawalreadyenablesinformation
sharingacrossrelevantagenciesandtheCourtforthepurposesofcoordinatingservicestobest
meettheneedsofthechild.

D. Technology and Data Sharing
1. The County needs to develop a clear, multi-system data linkage and sharing plan that would
operate as a single, coordinated system. (Include: DCFS, DPSS, DMH, DPH, Probation,
LACOE, and school districts at minimum. Also, partner with universities).
2. The CEO and Juvenile Court should co-lead the creation of a Countywide confidentiality policy
regarding a childs records and court proceedings to allow sharing of information across
relevant departments, agencies, persons, and the Court to serve the needs of the child and
increase the transparency of the system.

Review of Recommendation VII D Technology and Data Sharing

Page 35
Asallowedbystatutes.LosAngelesCountyhasalreadydevelopedsystemandprocessesthat
enablethefollowingtypeofinformationsharing:
Typeof
InformationSharing
LegalAuthority Description
JuvenileCourtrecords
sharedwithothers
Welfare&InstitutionsCode
(WIC):827,830,18951(d),
18961.7and;
CaliforniaRuleofCourt5.552
Permitsthesharing ofrecordswithspecific
individuals/entities(e.g.courtpersonnel,relevant
counsel,treatmentproviders,thosesupervisingthe
youth,andMDTparticipants).
Healthrecordssharedwith
DCFSandProbation
Officers
CivilCode56.103 Permitshealthproviderstoshareinformationwith
DCFSandProbation(dependingonwhichsystem
thechildisin)forcoordinatinghealthcareservices
andmedicaltreatment.
Mentalhealthrecords
sharedwithDCFSand
ProbationOfficers
WIC5328.04 Permitsmentalhealthproviderstoshare
informationwithDCFSandProbation(depending
onwhichsystemthechildisin)forcoordinating
healthcareservicesandmedicaltreatment.
Educationrecordsshared
withDCFS
EducationCode49076(a)(1)(L) Permitsschooldistrictstoshareeducationrecords
withDCFSforyouthinoutofhomecare.
ItisimperativethattrainingbeprovidedtoCountystaffsothattheyunderstandthedatasharing
provisionsandthevariousstatuesthatenablethesharingofdata.
Asaresultoftheseprovisions,inMarch2012,DMHandDCFSinitiatedtheregularsharingof
certainmentalhealthinformationforthepurposeofcoordinatingthementalhealthcareof
childrenwithopenDCFScases.Onaweeklybasis,DMHandDCFSmatchclientrecordsand
shareinformationidentifyingthenameofthementalhealthprovideragency;contactinformation
forrenderingproviders;servicetypesandinformation.Informationsharingcontinuestooperate
undertheHealthInsurancePortabilityandAccountabilityAct(HIPAA)rulesandregulationsand
facilitatesateamingprocesstopromoteimprovedoutcomesforchildrenservedbybothCounty
departments.Additionally,asmentionedinSectionVIIF,DCFSrecentlycreatedtheStudent
InformationTrackingSystem(SITS)toallowforelectronicsharingofeducationrecordsbetween
DCFSandLAUSD.Thissummer,theSITSwillbeexpandedtofivemoreschooldistricts.
AnotherexampleofdatasharinginvolvesDCFS,DHS,theSuperiorCourtandtheStateworking
inpartnershipwithIBMtodevelopanautomatedsystemforgenerating,processing,approving,
anddistributingpsychotropicmedicationauthorizations(PMAs).TheautomatedPMAprocess
willshortentimelinesandmaterializeoperationalefficienciesbyenablingelectroniccompletion
ofmanyofthesemanualtasks,eliminatingthebackandforthfaxingandprepopulatinga
limitedamountofinformationontoautomatedforms.AnapprovedPMAwillbeelectronically
returnedtoallparties,aswellasdownloadedintotheyouth'sCWS/CMScaserecord.The
automatedPMAapprovalprocessisprojectedtoreplacelaborintensiveprocesses;reducepoor
prescribingpractices;andimprovegeneraloversightofproposedmedicationsforsysteminvolved
childrenandyouth.

ACTIONITEMSFORTECHNOLOGYANDDATASHARING

1.Continuedatasharingeffortsacrossdepartmentsandtrainstaffonthevariousstatuesthatenable
thesharingofdata.

Review of Recommendation VII E Relationship with Providers and Community

Page 36

TransparencyandRelationshipwithProvidersandtheCommunity
RegionalCommunityAdvisoryBodies(RCAs)

EachregionalofficehasreinstitutedaRegionalCommunityAdvisoryBody(previouslyknownas
RegionalCommunityAlliance)whosemembershipincludesfaithbasedorganizations,
communityorganizations,parents,fosterparents,relativecaregiversandformerfosteryouth.
TheRCAswillensureamoreunifiedapproachtocommunityengagementthatwillprovideinput
andfeedbacktostakeholdersandalllevelsofDCFSstaff.
Vision:Tohaveamoreunifiedapproachtocommunityengagement,includingcommunity
feedbackfromalltheregionalofficesthatcaninformtheDirectorsChildWelfareAdvisory
Councilandstaffintheregionalofficetoimprovetransparencybetweenthedepartmentand
itscommunitystakeholders.
Purpose:Engagetheteamwithlocalcommunitystakeholderstobuildresources,remove
barriers,enhancesupportoffamilies,understandcommunityneeds,andreviewrelevantdata
toimproveoutcomesforchildrenandfamilies.
TheRCAwillmeetregularlywithcommunitymemberstoworktowardbetteroutcomesfor
families,whilebuildinglongtermrelationshipsthatstrengthenthecommunityweserve.RCA
membershipateachofficewillincludeadiverserepresentationofcommunitystakeholders.
ManagementoftheRCAwillbethrougheachRegionalAdministratorandtheirmanagerswith
oversightbytheDeputyDirector,ExecutiveTeam,andtheDirectorsCouncil.
EachofficewilldesignateaStakeholderEngagementChampionresponsibleforcoordinationand
facilitationoftheRCAoutreachandmeetings.InformationfromtheRCAmeetingswillbe
sharedintheofficebytheStakeholderEngagementChampionandintheDirectorsAdvisory
Council,whichwillallowforregional,anddepartmentwideinformationsharingandproblem
solving.
ToensureaccountabilityandtrackachievementsoftheRCAs,DCFScollectsaquarterlyreporting
formfromeachregionaloffice.Informationcollectedfromeachofficeincludes:anupdated

E. Transparency and the Relationship with Providers and the Community

1. Greater disclosure, clarity, and inclusion should be a routine component of community
engagement from planning to review of outcomes and allocation of resources. A first step is the
re-establishment of community advisory councils that are attached directly to each DCFS
Regional Office. These advisory councils would be co-chaired by the community and its
respective Regional Office. In the past, SPA 6 effectively used this model in all three of its
offices.
2. Performance-based contracting on agreed-upon outcome measures by DCFS, other appropriate
departments and the contracting agencies for children and families should be adopted,
rewarding contracting agencies that achieve better results for the children they serve.
3. Capacity-building experts, including universities, should work with community based
organizations to enhance skills in grant application and administration, evidence-based practice,
program design and evaluation.

Review of Recommendation VII F Education

Page 37
membershiplist,meetingschedule,goalsandobjectives.Eachofficeisresponsibleforsubmitting
areporttotheDCFSExecutiveTeamandthedepartmentsBureauofOperationalSupport.
TofurthersupportRCAsustainabilityandeffectiveness,aStakeholderEngagementChampion
LearningCommunitywillbefacilitatedbytheDCFSCommunityBasedSupportDivisionona
quarterlybasis.TheLearningCommunitywillprovideaforumforregionalofficechampionsto
discusschallenges/barriers,lessonslearned,andprogresstowardsachievingbenchmarksof
success.

EDUCATIONCOORDINATINGCOUNCIL
In2004,yourBoardcreatedtheEducationCoordinatingCouncil(ECC)whichischairedbyJudge
NashandLAUSDBoardofEducationmemberMnicaGarcia.A23membercollaborativebody
withleadershipfromacrossLACountyhasjurisdictionoverDCFSyouth,probationyouthand/or
theireducation,isresponsibleforraisingtheeducationalachievementoftheseyouthtoequalor
surpasstheachievementratesofotheryouthnotinvolvedinthesesystems.TheECCiscurrently
workingon:
LocalControlandAccountabilityPlan(LCAP)Withtheliftingofrestrictionson
categoricalfunding,schooldistrictsmustcreateLCAPstoidentifyhowthesedollarswillbe
usedtoservetargetedpopulations,includingfosteryouth.TheECCisservingastheAdvisory
bodyoverseeingtheLCAPsforeachschooldistrictandispartneringwiththeNationalCenter
ACTIONITEMSFORRELATIONSHIPSWITHPROVIDERSANDTHECOMMUNITY
1. EstablishRegionalOfficeCommunityAdvisory(RCAs)bodiestocoordinateandfacilitate
theRCAoutreachandmeeting.

F. Education

1. The County should establish mechanisms for cross-system education-related coordination,
collaboration, and communication. They endorse the structure of the ECC, and they should
continue to establish additional mechanisms for cross-site collaboration. The new child welfare
structure proposed by the Commission must joint engage DCFS, Probation, school systems, the
courts, and community partners to create cross-system goals and strategies to improve
educational continuity, stability, and academic success for foster youth.
2. The County should increase access to early intervention services for foster children and
children at high risk of abuse and neglect. All children under the supervision of DCFS between
0-5 should be prioritized for access to Early Childhood Education learning programs, including
Head Start, Early Health Start, and Home Visitation. These programs should be funded and
well marketed. Once placed in a program, children should be permitted to remain enrolled until
they start kindergarten.
3. The County should ensure that school stability and child safety are improved through
Countywide expansion of the pilot program that has been proven effective in the Gloria Molina
Foster Youth Education Program.

Review of Recommendation VII F Education

Page 38
forYouthLawwhowillbeworkingwithall81schooldistrictstodevelopplans.LAUSDhas
budgeted$9millioninFiscalYear201415tohiretocounselorstoworkspecificallywithDCFS
youthataratioofapproximately1counselorforevery100DCFSyouthintheirdistrict.
StudentInformationTrackingSystem(SITS)SITSisapartnershipcreatedbetween
DCFSandLAUSDtoelectronicallyshareattendanceandacademicinformationonDCFS
childrenandyouth,andinexchangesharethecontactinformationfortheyouthssocial
worker.SITSisnowfullyoperationalandholdsdataonthe5,800DCFSyouthwithopen
casesattendingLAUSD.Expansioneffortsareunderwaytoincludeanotherfiveschool
districts(LongBeach,Compton,Pomona,Pasadena,andAntelopeValley)bysummer2014;
approximately50%ofDCFSyouthwillbecapturedinSITSwhenthisexpansioniscompleted.
EARLYCAREANDEDUCATION

CurrentDCFSeffortstoincreaseaccesstoearlycareandeducationprogramsinclude:
DCFSContractwithCaliforniaDepartmentofEducationDCFSadministers$10million
invoucherstoprovideyearroundfulldaychildcareservicesforDCFSyouthwhose
caregiversworkandhaveaneedforchildcare.Inmostcases,thesevoucherscover100%of
theprogramcosts.Theseservicesareavailabletoyouthagesbirththrough12years,are
offeredforuptooneyear,andareprioritizedforyouthresidingwitheitherabirthparentor
relativecaregiver.
DCFSautomaticreferralsystemIn2011,DCFScreatedanautomatedsystemforreferring
itsthreeandfouryearoldchildrentoearlyeducationprograms.Itisestimatedthatabout
55%ofDCFSthreetofouryearoldchildrenarereferredtotheseprograms,androughlyhalf
oftheseyouthareenrolled.In2013,11oftheDCFSdistrictofficesreferredroughlytwothirds
oftheireligiblethreeandfouryearoldchildrentoearlyeducationprograms,andtwooffices,
SouthCountyandVermontCorridor,referred100%oftheireligiblethreeandfouryearold
childrentotheseprograms.

PromotionofearlycareandeducationprogramsStartingin2010,DCFSconducts
annualpresentationstoitssocialworkersineachregionalofficeonthevalueandbenefitsof
enrollingchildrenundertheageof5inqualityearlycareandeducationprograms.These
presentationsaregivencollaborativelybyDCFS,LACOEHeadStart,andChildCareResource
andReferralAgencystaffandincludeguidanceonnavigatingtheseprogramsandspecific
contactinformationforconnectingthesechildrentothevariousresourcesavailable.
GLORIAMOLINAFOSTERYOUTHEDUCATIONPROGRAM(FYEP)
TheGloriaMolinaFosterYouthEducationProgram(GMFYEP)wasdesignedtoensurethatDCFS
highschoolstudentsgraduatefromhighschoolandhavethesupporttheyneedtoenrollinpost
secondaryeducation,iftheydesire.TheGMFYEPiscurrentlyserving248DCFSyouthinseven
schooldistricts(Pomona,Montebello,HaciendaLaPuente,ElMonteUnion,Azusa,ElRancho,
andLosAngelesSchoolDistricts),andworkingonexpansioneffortstothreemore(Bonita,
BaldwinPark,andMountainViewSchoolDistricts).
TheCountywideexpandedprogram,knownastheFosterYouthEducationProgram(FYEP),was

Review of Recommendation VIII G Mental Health

Page 39
launchedinSeptember2012andspansacrossallfiveSupervisorialdistrictsin18differentschools
across4schooldistricts(LosAngeles,LongBeach,Compton,andAntelopeValleySchool
Districts).DCFSwouldliketofurtherexpandtheremedialtutoringportionofthismodeltofour
additionalschools(acrossLosAngelesandLongBeachUnifiedSchoolDistricts)andistryingto
identifyfundingtodoso.
FYEPThereare192highschoolstudentscurrentlyservedthroughtheCountywideFYEP
expansionprogram(125throughschoolbasedsocialworkersandindividual/groupremedial
tutoring,and67throughafterschoolremedialtutoringonly)
GraduationRates:Lastyear(201213schoolyear),23outof25seniors(92%)graduatedfrom
highschool(twoyouthwhodidntgraduatearestillworkingtowardsgraduation),compared
tothegraduationrateof48%forfosteryouthinCalifornia(StuartFoundation,2013).
PostsecondaryEnrollment:Lastyear,17outof25seniors(68%)enrolledinpostsecondary
education(12incommunitycolleges,5in4yearcolleges/universities),comparedtothe
nationalaverageofbetween713%forfosteryouth(CaseyFamilyPrograms,2010).

NONPHARMACOLOGICALINTERVENTIONS
Providingnonpharmacologicalinterventionsforchildrenwheneverfeasibleisclearlydesirable.
ThisrecommendationcanbeimplementedusingtheLosAngelesCountydependencycourts
programthatisdesignedtoreviewtheappropriatenessofprescribedmedicationsfordetained
childrenandtoexaminewhetherprescribingpractitionershaveattemptedpsychosocial
interventionspriortoorconcurrentwiththeintroductionofpsychopharmacologicalapproaches.
Morespecifically,theJuvenileCourtMentalHealthServices(JCMHS)isamultidisciplinaryteam,
basedprimarilyatEdmundD.EdelmanChildrensCourtthatprovidesconsultationtothevarious
dependencycourtsonmentalhealthissues.EachyearJCMHSreviewsover10,000psychotropic
medicationauthorizations(PMA),requests;whicharerequiredwhenpractitionerswishtotreat

ACTIONITEMSFOREDUCATION

1.ContinueexpansioneffortsfortheSITStoincludefiveadditionalschooldistricts.
2.IdentifyfundingtoexpandtheremedialtutoringportionoftheFYEPmodeltofour
additionalschools.

G. Mental Health

1. The Board should issue a clear mandate that non-pharmacological interventions are best practice
with children wherever feasible. The Board should work with the Juvenile Court to fully
implement and measure compliance with this mandate.
2. As part of performance-based contracting, mental health treatments for teens and transitioning
youth must incorporate trauma-focused assessments and treatments, developmental status,
ethnicity, sexual identify, and vulnerability to self-harming behaviors.
3. Children age five and under in the child welfare system must have access to age appropriate
mental health services.


Page 40
youthinStatecustodywithpsychotropicmedication(s).Eachformisreviewedbyachildand
adolescentpsychiatristandapharmacist.Subsequently,arecommendationismadetotheCourt
astowhetherornotconsenttoadministerthemedication(s)shouldbegranted.
Recommendationsarebasedonthereviewersextensiveclinicalexperience,aswellasvarious
prescribingparameters.JCMHSalsoprovidesconsultationtojudicialofficersanddependency
attorneysregardingmentalhealthtreatmentandpsychotropicmedicationregimensavailableto
dependencyyouth.
InMay2013,inordertobetterstandardizeandguiderecommendationsmadetotheCourtrelated
totheappropriatenessofpsychotropicmedicationregimensfordependencyyouth,JCMHS
implementedtheaforementionedParametersForJuvenileCourtMentalHealthServices
(JCMHS)ReviewofPsychotropicMedicationAuthorizationForms(PMAFs)ForYouthInState
Custody.PMArequeststhatdonotcomportwiththeseparametersresultinanautomatic
referraltoaJCMHSchild&adolescentpsychiatrist(whoworkincollaborationwithaJCMHS
socialworkerorpsychiatricnurse)forassessmentregardingtheappropriatenessoftheproposed
psychotropicmedicationregimen.Thisassessmentincludesadditionalrecordreview,contact
withtreatmentprovidersand/orfosterparents,andafacetofaceevaluationofthechildathome,
school,orboth.Inordertocompletetheseconsultationsinatimelyfashion,JCMHShasadded
1.5FTEofchild&adolescentpsychiatrists.Attheconclusionoftheassessmentprocess,JCMHS
providesawrittenreporttothecourtoutliningrecommendationsfornonpharmacological
interventionsand,ifappropriate,specificmedicationrecommendations.
CurrentInitiatives
A. InformationSharingProjectsareongoingtoimproveandsystematizethewayDCFS,DMH
(viaJCMHS),DHS,Probation,andtheCourtcommunicateandexchange/accessinformation
relatedtothePMAprocess.Theseinclude:
1) Developmentofanew,electronicJV220(A)submissionandreviewsystemwhichwill
improve:
ThespeedandaccuracywithwhichDCFSsubmitsimportantcollateralinformation
abouttheyouth;
TherapiditywithwhichJCMHScanreviewboththeJV220(A)andavailable
collateralinformationand,subsequently,makearecommendationaboutthe
medicationregimenssafetyandefficacy;
ThebreadthofdatauponwhichtheCourtbasesitsmedicationapproval(ornon
approval)decisions;
TheabilityforDCFS,JCMHS,andtheCourttoreviewprescribingpatternsona
systemic,facilityspecific,orindividualprescriberlevelandtodetermineifnon
pharmacologicalinterventionswereimplementedpriortoorinconjunctionwith
psychotropicmedication(s)beingprescribed.
2) SystematizingthemannerbywhichDCFSsubmitsancillaryinformation(bothpriorto
andaftertheimplementationofthenewdatasystem).
3) GrantingJCMHSstaffaccesstotheChildWelfareServices/CaseManagementSystem
(CWS/CMS)statesystemsothattheyhaveaccesstomoreinformation/dataregarding
priorpharmacologicalandnonpharmacologicalinterventionsthathavebeen
implementedinyouth.


Page 41
4) ImprovingtheavailabilityofyouthsDCFSHealth&EducationPassporttocommunity
providersandtheJCMHSstaff.
B. ImprovingGroupHomePrescriberQualificationsEffortsareunderwaytohelpensure
thatpsychiatristswhotreatDCFSyouthhaveaminimumleveloftraining,experience,and
qualifications,althoughtheexactlevelofcertificationthatwillberequiredhasnotyetbeen
determined(e.g.,certificationingeneralpsychiatryand/orchildandadolescentpsychiatryby
theAmericanBoardofPsychiatryandNeurology).Thiswillimprovegreatlythelikelihood
thatfosteryouthwhoeventuallyaretreatedwithpsychotropicmedicationshavebeen
properlyassessedandmonitored,andhavebeentreatedorwillbetreatedwithappropriate
nonpharmacologicalmodalities.
MENTALHEALTHASSESSMENTANDTREATMENTOFTEENSANDTRANSITIONINGYOUTH

DMHrequiresallproviderstodelivercomprehensiveassessmentsofadolescentsusingprotocols
thatincorporateStateMediCalrequirements.BothDMHandStateDHCSmonitorproviders
completionofassessmentsasacomponentoftheStateMediCalReviewandtheDMHprovider
MediCalrecertification.Table1comparestheextenttowhichtheseassessmentprotocols
includedevelopmentalstatus,traumafocus,sexualidentityandvulnerabilitytoselfharming
behavior.Allassessmentsaddresstraumaandvulnerabilitytoselfharm.Bothchild/adolescent
andjuvenilejusticechild/adolescentassessmentsinquireaboutdevelopmentalstatus.However,
onlythechild/adolescentinitialassessmentaddressessexualidentityfromthedevelopmental
milestoneperspective.
Table1:ComparisonofThreeMentalHealthAssessmentsbyVariousComponents
COMPONENT
MENTALHEALTHASSESSMENT
AdultInitial
(MH532)
Child/AdolescentInitial
(MH533)
JuvenileJustice
Child/Adolescent(676)
Age 18+ 617 617
Ethnicity
DevelopmentalStatus Notspecificallyasked
Traumafocused
SexualIdentity Notspecificallyasked * Notspecificallyasked
VulnerabilitytoSelfharm
Indicatesitemisincludedinassessment*Developmentalmilestones
Inadditiontothesecomponents,asastandardofclinicalpractice,allchildrenandyouth
receivingservicesfromDMHareassessedforthepresenceorriskofcooccurringsubstanceuse.
Theseassessmentsareusedtoplaninterventionsdeliveredbymultidisciplinaryteams.
Currentstrategiesforaddressingissuesoftrauma,sexualidentityandvulnerabilitytoself
harmingbehaviors,andrecommendationsforfutureinitiativesareasfollows:
TraumaFocusedTreatmentsThroughtheMentalHealthServicesAct(MHSA)Prevention
andEarlyIntervention(PEI)DMHworkforceandprovidershavebeentrainedtodeliveran
arrayoftraumafocusedtreatmentinterventionsincludingTraumaFocusedCognitive
BehavioralTherapy;SeekingSafetyandCrisisOrientedRecoveryServices.AllDMHproviders
ofservicestochildrenandtransitionageyoutharerequiredtoofferatleastoneEvidence
BasedPractice(EBP)addressingtrauma.


Page 42
SexualIdentityTheMHSAPEIstakeholderplanningprocessrecommendedprioritizing
servicestoLesbian,Gay,Bisexual,andTransgender(LGBT)youthandyoungadults.During
thepastfewyears,DMHhasimplementedanoutreachandpsychoeducationprojecttothe
providercommunityregardingservingLGBTTAY.DMHwillenhancetrainingopportunities
thatenableproviderstoeffectivelyidentifyandaddresssexualidentityissuesamongclients.
SelfHarmingBehaviorsDMHusesanarrayoftoolsandresourcesinourefforttobetter
understandandreducetheriskofselfharmingbehaviorsinadolescentsandyouth.Riskfor
selfharmingbehaviorisassessedconsistentlythroughoutthecourseoftreatment;especially
whentheindividualisreportedtobeorobservedtobedemonstratingsignsorsymptomsof
selfharmingintentorbehaviors.Additionally,DMHhasarigoroussuicideprevention
programwhichincludesdesignatedstaffconductingtrainingtothementalhealthprovider
community,faithcommunities,andnonmentalhealthcommunitybasedorganizations.
DMHtrainedseveralhundredDCFSstaffinsuicidepreventionduringthelasttwofiscalyears.

DMHhasadraftpolicyregardingtheuseofstandardizedtoolsforassessingriskofselfharmand
willensureprovidersusesuchtoolsonceidentified.
CHILDRENZEROTOFIVEYEARSOFAGE
AsnotedintheBRCCPReport,childrenbetweenzeroandthreecontinuetobetheagegroup
mostlikelytobemaltreated...andmorethanhalfofnewlydetainedchildrenareunderage
five.Thereportfurtherstatesthatitiscrucialforthementalhealthsystemtocontinuetobuild
capacityandstrengthencompetenciesinthefieldofinfantandearlychildhoodmentalhealth
specificallyforthoseinfantsandchildreninthechildwelfaresystem.DMH,inpartnershipwith
DCFS,otherdepartments,andalargenetworkofprovidersandpartneragencieshasclearly
targetedanarrayofpreventionandearlyinterventionresourcestowardchildrenbirthtofivewho
areinoratriskofenteringthechildwelfaresystem.
EvidenceBasedPracticesHighqualityandageappropriatementalhealthservicesinclude
anumberofEvidenceBasedPractices(EBPs)thatarefocusedontheneedsofyoungchildren
particularlythosewhohaveexperiencedtraumaand/orareatriskforpsychosocial,
emotional,andbehavioralproblemsrelatedtoabuse,neglect,anddevelopmentaldelays.
ComparativedataforDCFSinvolvedchildrenindicatethatinFY201213,almost10,000
receivedtreatmentsusinganevidencebasedorpromisingpractice,comparedto9,000inFY
201112.Duringthistwoyearperiod,over5,000childrenagebirthtofivereceivedsuch
services.Moreover,eachyear,thenumberofchildrenunderagefivewhoarepartofthe
KatieA.Classandhavereceivedmentalhealthserviceshascontinuedtoincrease
(approximately7,100inFY201112,and7,860inFY201213).Thisincludesincreasinglylarger
numbersofinfantsandtoddlersunderagethree.
BuildingCapacity:BirthtoFiveTrainingandWorkforceDevelopmentDMH
childrensmentalhealthprovidershavebeentrainedinanarrayofEBPsappropriatefor
childrenunderfive.Nearly200legalentityprovidersitesarecurrentlydeliveringsuch
practices.AmongtheEBPs,ParentChildInteractionTherapy(PCIT)hasbeendocumentedas
aneffectivepracticeforreducingtheincidenceoflowtomoderatelyseveredisruptive
behaviorproblemswhichdramaticallyincreasetheriskofphysicalabuseofyoungchildren.


Page 43
First5LAawardedafiveyearPCITtraininggranttoDMHandtheUCDavisPCITTraining
CentertoformtrainmentalhealththerapiststobecomecertifiedinPCIT,increasethe
numberandgeographicdiversityofqualifiedPCITproviders,anddeliverPCITservicesto
eligiblechildrentwotofiveyearsoldandtheirparents/caregivers.DMHhascollaborated
withDCFStoidentifyfocalpopulationsofchildreninoratriskofenteringfostercareaswell
asparentingteensandtheirchildren.SincetheinceptionoftheprojectinOctober2012,the
numberofPCITprovidershassignificantlyincreased(upto20eachyear)andover500DCFS
involvedchildrenandtheirparents/caregivershaveparticipatedinPCIT.
Inadditiontoadministeringprogramsdesignedtoaugmentprovidercapacitytodeliverbest
practicesforyoungchildren,DMHsponsoredrecentmeetingsoftheICARESteering
Committee(ISC),asubgroupoftheInfancy,ChildhoodandRelationshipEnrichmentorICARE
Network.TheISChasbeendevelopinganLACountyPrenataltoFiveTrainingand
LeadershipConsortium(TLC).TheConsortiumisfocusedonachievingthefollowinggoals:
Augmentpathwaysandenhanceopportunitiesformentalhealthprovidersto
becomeInfantFamilyandEarlyChildhoodMentalHealth(IECMH)specialists
(includingmeetingtheendorsementprocessrequirements).DMHhascontractedwithUSC
UniversityCenterforExcellenceinDevelopmentalDisabilitiesChildrensHospitalLos
Angeles(UCEDDCHLA)toimplementaBirthtoFiveCoreTrainingSeriesthatwillultimately
enable1,000participantstoreceivetraininginBirthtoFivecorecompetencies.UCEDD
CHLAwillfurtherprovidereflectivefacilitationtrainingforoverthirtyclinicalsupervisors.
EstablishanLACountyTransdisciplinaryLeadershipConsortiumthatpromotes
capacitybuildinginsupportofcomprehensivesystemsofcarewithinlocalService
Areas,BestStartLAcommunities,andHealthNeighborhoodsthroughcrosstrainingfor
representativesfromtheearlycareandeducation,mentalhealth,healthcare,developmental
disability,andchildwelfaresystemsthatcanbesupportedthroughmultiplefundingstreams.

ACTIONITEMSFORMENTALHEALTH

1. Improveinformationsharingbydevelopinganewelectronicformattosubmitandreview
informationrelatedtothePMAprocess.
2. ProvideJCMHSstaffaccesstotheCWS/CMSsystemtoviewmoreinformationregarding
priorpharmacologicalandnonpharmacologicalinterventionsprovided.
3. DeterminetherangeofservicesandsupportsfortheLGBTTAYpopulation.
4. Selectasetofstandardizedtoolstoaccompanymentalhealthassessmentformsto
determinevulnerabilityofyouthtoselfharmingbehaviors.
5. Administerprogramsdesignedtoenhanceprovidercapacitytodeliverbestpracticesfor
youngchildren.

Review of Recommendation VIII Oversight Team

Page 44
VIII. Establish an Oversight Team to Ensure Implementation of Recommendations

The Board should immediately establish an Oversight Team. Initially, the Oversight Team would be charged
with the following tasks:

1. Oversee implementation of the Commissions recommendations upon adoption by the Board.
2. In collaboration with the Board, identify the services currently provided by the Departments of Health
Services, Children and Family Services, Public Health, Probation, Mental Health, Public Social Services,
First 5 LA, the Los Angeles Office of Education, the Domestic Violence Council, and the Housing
Authority of the County of Los Angeles deemed as crucial to ensuring child safety. The accompanying
budget and staff resources also should be identified.
3. The Oversight Team must develop a dashboard to provide monthly report to the Board.

AnOversightTeamcouldbeestablishedthroughanordinancewithamandatetooverseethe
implementationofthoseBRCCPsrecommendationsthatwereapprovedbytheBoard.In
developingtheordinance,itwillbeimportanttodeterminethemembership,lengthofterms,and
cleardefinitionofthedutiesbeingrequestedtoundertakeanddeterminewhichinformationthey
shouldlegallyhaveaccessthatisallowableunderstateandfederallaw.Weconcurthatthe
Oversightteamshoulddevelopamonthlydashboardthattheycanusetoprovideupdatesonthe
BRCCCPrecommendations,ifapprovedbytheBoard.
TheBRCCPhasaskedthattheBoardtocreate:
AJointStrategicPlanningprocess.Tomeetthisobjective,yourBoardcouldcreatethe
LACWCCouncil;
TheOfficeofChildProtectionwithanExecutiveDirectorwithbudgetandstaffingoversight;
and
AnOversightTeamresponsibleforimplementation.
IftheBoardsupportsthecreationofalltheseentities,itisimperativethattherolesand
responsibilitiesoftheseentitiesbeclearlydelineatedsothatwearenotduplicatingeffortsand
thefocusremainsontheimplementationofcriticalstrategicobjectivesforchildrenandfamilies
withinLosAngelesCounty.

ACTIONITEMSFORESTABLISHINGANOVERSIGHTTEAM

1.EstablishoversightteamtooverseetheimplementationoftheCommissionsreport,upon
adoptionbytheBoard.

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