AACCA Position Statement

The Alabama Association of Child Care Agencies (AACCA) offers the attached Position Statement to those concerned about the welfare of children in Alabama. This Position Statement was developed in view of a recent Order issued by Judge DeMent pertaining to the RC Consent Decree. With concern for children and families at risk, we humbly commit the contents of this document to your due consideration and judgement. We invite any feedback or discussion of the matters addressed

Position Statement
Adopted August 9, 2005
By
The Alabama Association of Child Care Agencies (AACCA)
Regarding District Court Opinion and Order in the RC Consent Decree, Document 752
Case Document Filed May 13, 2005

INTRODUCTION: The Alabama Association of Child Care Agencies (AACCA) is comprised of 27 agencies that provide an entire range of services for children who require intervention by the Alabama Department of Human Resources. These agencies have a combined history of over 1000 years of operation and represent both non profit and for profit agencies. Many of our members have been involved in the R. C. lawsuit since its inception through numerous task forces, work groups, study groups, and the quality assurance process. Most of our agencies contract with the DHR to provide services to the class members of the R. C. consent decree. The members of AACCA believe that it is our professional responsibility to speak on behalf of the children and families that we serve. This statement is intended to represent the children and families we serve only. This statement is not intended to give support to or detraction from the statements of the plaintiff or the defendant.

It was with great interest that our members read the briefs of both the plaintiff and the defendant for the latest review by the Federal Court, followed by the order that was issued by the Court as a result of its careful review of the submitted briefs. This position statement is a direct result of those reviews and reflects our beliefs regarding concerns listed in the latest order. This position statement is also one that reflects our experience-based assessment of the status of children whose families require intervention by the State of Alabama. After some general comments on the Court's Order, we respectfully offer our views on five vital areas of concern, including specific recommendations in three of these areas.

GENERAL COMMENTS: The Court is to be commended for its strong statement regarding the safety of children. The safety of children must be of paramount importance for all involved in child welfare. Child safety is rightly listed as the critical area of concern for both the plaintiff and the defendant. The other goals of the consent decree flow from this area of prime concern and are meaningless if the goal of child safety is not first obtained.

There can be no doubt that there has been great emphasis placed on the satisfactory conclusion of this consent decree. As the Defendant's brief states, there have been massive increases in expenditures in our State in its effort to resolve this lawsuit. The funding for child welfare services has increased from 62 million dollars a year in 1988 to 286 million dollars in 2004. That is an additional 224 million dollars a year for child welfare alone. Entire new service industries have developed as a result of this consent decree. There are over 500 new direct service workers in child welfare. This consent decree has been in process for almost 17 years, which means that children born at the filing of this suit may not be able to benefit from its conclusion, as their age will disqualify them for child welfare services. New and emerging trends and knowledge are now available that were not available at the time of the consent decree. These factors as well as the institutionalization of this consent decree bear further scrutiny and research. We welcome the statement by the DHR in their strategic plan that indicates that “DHR desires to constantly strive for even better performance”. To make this statement operational, many of the items in the most recent court order must continue to evolve.

DATA GATHERING, ANALYSIS, AND QUALITY ASSURANCE: DHR has just begun publishing “report cards” for each county. This effort is to be commended. However, many questions will remain.

While these report cards may eventually establish trends, information on past trends is needed today. Knowledge of existing trends is essential for future planning. Longitudinal data for such things as child deaths, the number of children in out of home placements by type, the length of out of home placements, moves within the system, cost for services, staffing patterns (direct service and administration), outcomes of services, and the number of abuse and neglect reports must also be obtained.

This data should then be analyzed alongside other statistics for children such as the number of children in DYS custody, various child well-being scales that are produced, educational statistics, and statistics from the health department. Such data will provide indicators of the state of child welfare in Alabama. However, it is vital to note that they will only be indicators.

The effects of funding and policy implementation have great impacts on the indicators. An example of how policies affect statistics will provide more clarity. The policy concerning reporting of suspected child neglect or abuse is one of critical importance not only to children but to the resolution of the consent decree. To understand a trend in the decrease or increase of reports, it is essential to understand the policy that guides the taking of reports and the various mechanisms that are used to categorize reports. It would also be essential to know if there are efforts aimed at increasing reporting of possible abuse. While statistics are vital in gaining a perspective, the forces behind the statistics are, at times, even more important in the lives of children and families.

RECOMMENDATION: Toward the end of assuring accurate, current and longitudinal data and analysis along with related funding and policy information and analysis, AACCA recommends that the Quality Assurance component of the consent decree become separate and independent from DHR and DHR control.

This independent QA System must establish better mechanisms to receive data from the counties and to allow the counties to receive data from the State level. This would assist in sharing knowledge based on experience, and it would provide one more mechanism to ensure the sustainability of the conversion process. This group could then delve beyond statistical reporting into the root causes that created the statistical information. This recommendation for an independent QA system is one that has been promoted by various other child welfare advocacy groups such as the Alabama Foster and Adoptive Parent Association and Alabama Family Ties.

ISPs AND ASSESSMENTS: The driving practice force behind the entire consent decree and implementation has been the development of appropriate Individual Service Plans (ISPs). The ISP determines all aspects of the involvement of the State in the life of a child and his/her family. While ISPs direct the service provision and related decisions, a method to develop a comprehensive assessment of the needs of the child and family has only recently begun. AACCA and others have long asserted that without a consistent, reliable tool and process relating to assessment of needs, the ISP process itself could never live up to the hope that has been placed on it. We commend the current leadership of DHR regarding the initiation of this process in some areas of the State. This process needs to be expanded, monitored, and evaluated by the Q.A. process described above as one important aspect of the ISP being able to reach its full potential.

RECOMMENDATION: AACCA recommends implementation of a consistent assessment tool statewide to be utilized by the ISP process as an important part of assuring consistently good decisions for children and families.

SOCIAL SERVICE AND MEDICAL MODELS: The State of Alabama, as indicated the Defendant's brief, relies heavily on federal funding to meet the needs of children and families. The use of Medicaid as one of the primary mechanisms for funding services has moved child welfare to more of a medical model of care. Many of the mandates of the consent decree are based on a social service model. This movement is a prime indicator of the mental health needs of the children and their families. There needs to be a concerted effort to determine these needs and develop a mechanism that incorporates both the medical and social service models for meeting the needs of children and families.

NUMBER OF CHILDREN IN CARE AS AN INDICATOR: As the court order indicated, there are more children in foster care now than when R.C. was first implemented. We note that the statistic appears to be considered an indicator. We do not consider that to necessarily be the case at all. While we certainly appreciate the fact that there is a need to work with families more on the front end, there are variables that must be considered in order to form appropriate conclusions from variations in numbers in care. If children are not safe, they must be removed from those unsafe environments. Adequate assessments of children and families and adequate ISPs are the only means of making good decisions on their behalf, including determining which placement best meets the needs of children. The State has only recently begun use of a standardized assessment tool. As previously stated, this practice, coupled with an on going evaluation of the tool, must become standard practice. Currently children are classified as needing differing levels of care based on perceived need by the DHR caseworkers through the ISP process. The high turnover and often low tenure of the caseworkers does not provide sufficient safeguards for placement decisions nor for future planning of the system. That is especially true when considering the skills and relationship-building so crucial to successful ISP processes. Also, the number of completed ISPs does not seem to have a standard as to the definition of an ISP. What, precisely, is being measured in saying that an ISP is completed? Finally, as FBI statistics indicate, child abuse is probably the most under reported crime in America. Many societal/familial factors influence trends in terms of the number of children in care. One example would be the relatively recent influx of children into care from methamphetamine manufacturing and abuse. These are a few of a number of reasons why it is our position that number of children in care is not necessarily a valid indicator of compliance or non compliance. Until there is a better handle on these variables, that statistic may or may not be a solid indicator.

PURCHASE OF SERVICES: The State of Alabama must rely on private providers of care for most of the therapeutic services required by children and their families. The procedures for contracting and financing these services deserve special attention, especially as they relate to meeting needs. Without the services of private providers, the R.C. consent decree could never be achieved. The processes of service definition, financial reimbursement, contracting, and evaluation should be considered in all stages of development; especially as it relates to insuring needs of children and families are being addressed. Current RFP requirements are limiting the ability of the Department to be as inclusive in service planning as private providers believe is in the best interest of children. Funding mechanisms, such as Medicaid, need to be reviewed and refined to assure many things crucial to children and families, including lowering any barriers related to getting the funding to the individualized point of need and assuring the continuing development of community based services according to identified needs.

RECOMMENDATION: AACCA recommends that the Board of DHR develop a standing committee to review, evaluate, and implement strategies for the purchase of services that assures needs of children and families are met while honoring the best interests of both DHR and community-based private providers.

The committee, while chaired by a DHR Board Member, should be comprised of an equal number private providers as well as State and County DHR representatives.

It is with great respect for the Court and with awareness of the dedication and diligence that is evident in its most recent Order that we share our observations and recommendations on the status of the RC Consent Decree. Our overriding concern is the safety and welfare of the children of Alabama. We are certain that this concern is shared by the Court and the parties involved.

Mac Otts
Alabama Association of Child Care Agencies
Executive Director
(251) 344-7733