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Senate | May 5, 2016 | Committee Room | Health and Human Services

Full MP3 Audio File

[BLANK_AUDIO] [BLANK_AUDIO] Members, take your seats. I 'd like to welcome everyone to the House Appropriations Committee on Health and Human Services. Our House Pages for the day are John Brit from Wayne County sponsored by Representative Dickson, Caroline Harris from Kit County sponsored by Representative Farmer-Butterfield, Taylor Gentry from Union County sponsored by Representative Ark. Thank you all for being with us this week. Our Sergeants-at-Arms, Young Bey, Jim Murran, Lesle Salisbury, Martha Gardison. [BLANK_AUDIO] Thank you all. Again, welcome to our committee. Today we have child and family services review, program improvement plan with staff from the Department of Health and Human Services with Kevin Kelly. At this time I'll turn it over to the department. >> Thank you Mr. Chairman, Members of the committee. My name is Kevin Kelly and I have the honor and privilege to serve as the section chief for the child welfare services section in DSS which is also in the department of health and human services. when I began this morning by talking a little bit about the background for the child and family services review, Which will lead into our planning to address those issues for an improvement plan, which is also required, so thank you for this morning. Just to remind everybody that child family services review is a federally driven review. Of all jurisdiction of child welfare services is all state that is conducted on a periodic basis but somewhat irregular, 2015 was North Carolina's third of such reviews the first being in 2001 and the second being in 2007. The purpose of this review. Is to insure that all state are in conformity with federal regulations governing child welfare services. Also determine what is actually happening to children and families as they were engaged in child welfare services and then finally to assist states in enhancing their capacity. Capacity to help some of the families achieve positive outcomes. The reviews are structured in such a way to help states identify strengths in areas needing improvement within agencies and programs. Overall the goal of the reviews is to help states improve child welfare services and the outcomes For some of the families that receive services. I wanna stress first and foremost that we should not see the review as a pass/fail audit or a test in that regard but really is an opportunity to find areas needing improvement. And by way of illustrating that point, no state has ever not Not had to execute an improvement plan following a review [BLANK_AUDIO] Little bit of background the Charm/g famous servisory/g was first authorized in 1994 by amending the social securities act final rules governing the review were published in 2001 As I said North Carolina was first reviewed in 2001 and we are privileged to be in what children's bureau refers to as year one state and that pattern continues for both subsequent rounds. So last year was North Carolina's Third review and what I would also want to point out is that there have been some significant changes made particularly between round two and this third round so it wouldn't be very valid to compare the previous round and those results With this round and this results the review is structured in such a way to intentionally make a very high bar for states to pass. Again it's trying to illustrate and find areas where improvements are most needed.The cart of the Champagne/g Services Review is Is focused on seven outcome measures and those outcome measures

are assessed through actual case reviews where 95% of the cases reviewed for each item must be found in substantial conformity for that overall outcome area to be determine. To be Also in substantial conformity. So that's really a very high bar again intentionally set that way. Within those outcomes there are seven and they are structured into three different groupings, safety, permanency and well being for children. I will walk through these just really briefly for you. Safety one One measures how timeliness we respond to reports of child maltreatment. Coupled with that case review for safety one are two data indicators from our data aggregate system which are looking at children who are reported to be maltreated while in the Foster care services and children who are re-reported and found maltreated more than one time in a given period. Safety outcome two, measures our ability to effect protective services to keep children in their own homes while assessing their risk and safety and managing those concerns. Permanency one, outcome measures vote the efforts to achieve permanency for children served by foster care services and the services to ensure children do not require movement while in placement in foster care. Similarly, child permanency two has date indicators associated they are actually five, four of which measure how quickly we can achieve permanency for children once the're brought into the foster care program. And then the final data outcome measures how frequently children have to move while they're in their spell of foster care. The second permanency outcome measures children's service to ensure children while in foster care services remain connected to their parents, their sibling and other family members. The final three outcome measures look at what is referred to as well being. Which as you can imagine is sometimes very difficult to measure. Well-being one is really what I think we see as the heart and soul, or the core practice of child welfare service. And this measures our ability to identify the needs for families and to provide appropriate services to address those needs. Well-being two looks at the agency's ability to assess and meet children's educational needs while being provided services. And well-being three looks at their physical, mental health. And I would point out that when we talk about physical health we mean dental care as well. So again to assess a state's functioning on those seven outcome measures. The children's bureau has a structured case review process referred to as the on-site review instrument. For 2015 this third round in North Carolina we were able to review 105 cases. 59 of children served by the foster care program, 46 children served while remaining in their own homes. We partnered with 10 counties you see listed there to conduct the reviews. One of the lessons learned from prior reviews that if the agency who provided services that is being reviewed, doesn't understand the process of that review, the outcomes and the results of that case review are very difficult to incorporate into further service performance enhancements. In the future our goal is to reach as many counties using this federal instrument as we possibly can. In addition to the seven outcome measures, the CFSR looks at seven systemic factors. And these are a little bit, or I should say much more difficult to measure. It is believed that when these factors are present, they are supporting components that contribute to possibility/g of programs and services within the child welfare umbrella. I will say and the children's bureau agrees that it is not such that these systemic factors have a standard of measurement that's looked across all jurisdictions or functionality on these factors. The essence of the means by which these are measured is based on the state's ability, first and fall /g to provide data, to the children's bureau and then also to engage with stake holders to see if , for each of systemic packers that relate to their work, whether or not they believe the state is adequately supporting those factors. As we're working with Anti foster Case Management System,

we see lots of potential future for being able to better measure using data, on how our system is performing on the systemic factors. And they're listen on the screen for you. [BLANK_AUDIO] So following the review and receipt of and even at prior to receiving the final report, we begin in earnest bringing together stakeholders from across the state,starting as early as we could in January, right after the holiday break. January 11th and 12th we held a two day meeting with nearly 300 participants to go over the report, we had children's bureau staff in North Carolina to help us with that, to share observations and to begin drilling down as to what were some of the underlying root causes of the results that were observed I will point out that, the plan allows for 2 years of activities and a third year for which monitoring of our progress on the plan will continue. Those dates are fixed and [UNKNOWN] record and we're not allowed to make any modifications to those. Subsequent to that, we found five thematic areas that we thought that would really help us identify, really effective and efficient ways to address these. You see them listed on there and the intend was to provide, any cross cutting areas in these thematic groups as we possibly could while still providing some structure for the participants to be able to again drill down a little deeper and to make suggestions as to what improvements might be able to be made to effect positive change. Our intention here was to Not provide quick fixes to what we saw but rather really look at long term systemic changes that needed to be made in place because we know there's always gonna be a fourth round of the reviews and ultimately what we really want are on going continuous quality improvement to improve services to children and families. [BLANK_AUDIO] Looking at the structure of the plan that the Children's Bureau has dictated there are actually three levels that must be articulated in the plan. They refer to goals, strategies and activities. This is another area that has changed significantly since around two in 2007. To give you an example in 2007, our plan was 108 pages of really detailed narrative descriptions of activities and things that we thought we would do and that was one of the feedback we gave the children's bureau for improvement we were very happy they responded to that. Our plan is still in draft. At this time we've identified five broad goal areas for improvement. Each of those five goals has several strategies and again under each strategy there are several level activities. I'm gonna go through and try to highlight at a goal level cuz that really gives you an idea what the primary issues driving performance is. And again I want to reiterate our federal partners are deeply engaged with us in the plan development. To give you an example we have at least two hour calls once a week with our federal partners and providing updates to that plan each week as we improve the plan and meet their expectations for what that plan should look like. The primary feedback that we've received at this time is the Children's Bureau wants to ensure that North Carolina does not articulate anything in the plan that can not be achieved in that two-year time period. So our first goal is very broad and really again at the heart of what we think about child welfare services the goal is to clarify and establish clear performance expectations at each service area for child welfare services. And we generally refer to Three areas. Child Protective Services, Foster Care Services and Adoption Services. The Child Family Services really doesn't look at adoption services but does look at what we referenced earlier as what we'd referred to as in-home services. Theses are situations where a child has been found to To be maltreated but can be safely maintained in their own home while services are provided to try and ameliorate those conditions contributed to that case decision. The goal here is really to strengthen and clarify our policies and other written guidance materials for front line social work Workers to execute consistently the aim is to explain a very complex set of skills as clearly as we possibly can which will help improve

the delivery of system. I think we owe it to the workforce as new workers come on board because we do have our and every state has significance turnover rate in the sealed to articulate the various aspects of what I think is one of the most difficult jobs and again the workforce turnover is one of the things we need to make sure we make clear attention to. [BLANK_AUDIO] In order to clarify those performance expectations for the field, there are several brackets they were paying attention to, one is to enhance the training system that we have in support of good social work practice. We heard clearly that additional training of the workforce is absolutely necessary. Additional training will need to focus on ensuring that the participants are acquire the knowledge skills and most importantly the abilities to practice the necessary actions when executing their job duties, this is often referred to as competency based training. Currently we have four training sites across North Carolina where most of the training is conducted. Those sites are Asheville, Charlotte, Greensboro and Fayetteville. What we proposed to do in the future is to meet the field more closely to where they are to remove some of the barriers in travelling to one of those four sites. So we're seeking to deliver training in a more responses manner again in [UNKNOWN] were we see the various need. We're also looking to enhance our ability to [UNKNOWN] training to supervisors and we're referring that as a supervisor academy. We do provide training today to supervisors but what we really want to be able to do, is to have the supervisor as sort of the first back up because every social worker needs a support system and we think the supervisor conserve as that at first level of support to ensure that family is wholly assets and that appropriate services are carried out. The other part of establishing clear performance expectations to make sure we have a ready workforce as they enter the field of child welfare in partnership with multiple univer. We began the planning process to develop and enhance our training and support even while the students are still in their post-secondary education hopefully a school with social work. This is to ensure that skills are transferred into practice and to spot clear expectations. We also understand that training alone isn't the solution to this, whether it's at the worker level Or the level and that the state needs to provide additional technical assistance who are challenged have their workforce execute services effectively in order to provide that technical assistance we are looking at what data we have including the results of. Program monitoring that is taken place during the past year, looking at other information that we have such as the CPS evaluation that was conducted last year. This administration invested significantly last year and what we referrer to as listening session. And that data has been very instrumental in helping us. Target our technical systems to where areas our performance are most needed to improve. We also want to establish that, while we do have 100 counties in North Carolina, many of these issues are cross cutting multiple counties and that particularly for smaller counties to be able to To build in supports so that we will deliver the training in a regional manner so that they can continue to enhance and support each other and maybe look at efficiencies that were specific services might be able to provided in a multi county kind of approach. The second goal that we've identified is to strengthen our quality of sharing system.And I spoke briefly about some of the activities that we've already under way to assure that the services are delivered in a quality manner. Again, what we really want to do is build on the Federal instrument know as the onsite review instrument and to be able to roll that out to additional counties. As the review itself eliminated that instrument while requires a significant amount of investment to execute does provide a deeper look into how Services are or are not being provided effectively. To give you an example of how deep that review is, the average case

takes a full day to find out whether or not services were provided effectively. And that's two individuals working the whole day, so really two person days in order to execute that Case review instrument. We also are looking at again those program monitors that have been conducted over the past year. Those evaluation reports I think are very instrumental in enhancing our quality assurance system and to be able to better measure performance across all 100 counties The more difficult part for us it's very difficult to take the complex field of child welfare services and provide analytical data but that can be done and it's although not easy, what we hope to do is to better Make that information more objective. And that really speaks to goal three is to improve the outcome for permanency for children and by partnering with the judicial system, that data is somewhat more structured not only for the Department of Health and Human Services But from the court system, they have a data capturing system, they refer to as JAWS. And we're proposing in our plan and in our other activities to partner with the administrative office, The Cords, who oversees the JAWS systems and merge those two date sets together to provide a more robust A robust picture of where children are achieving permanency more timely and where jurisdictions need to improve that timeliness as well. [BLANK_AUDIO] Our forth goal will probably not be a surprise to anyone, but I wanna take it Articulate that Child Welfare Services while we provide a county departmental services rely heavily on other service areas.Such as the Behavioral Health System.And we're proposing to partner, continue more deeply with the Elomi MCO system to make sure that children And their family members are adequately and timely assessed for their behavioral health needs, mental health, substance abuse is obviously pre-dominant in child welfare families. And that by enhancing out partnerships and our ability to establish clear service performance Performance expectations, for the providers that they and their networks. Then we believe that we can more effectively serve children and families in the child welfare services system. And then somewhat overlapping with that we have a public-private partnership for child placement services Services often referred to as family foster care or therapeutic family foster care. And those provider partners are key also to ensuring that children and families are served when children are brought into the foster care program. The fifth and final goal in our formal plan For the federal government review is to enhance our statewide data quality. I've mentioned briefly NCFast, the Children's Bureau has invested and approved the NCFast plan, so they understand that is on board as well. We do not specifically talk Ncfast to the federal improvement plan again because of the schedules don't exactly line up and that the Children's Bureau doesn't North Carolina to implement NCFast before already, and it might be that the program [UNKNOWN] Plan Period Prior to the actual and full implementation of NCFast. We do have and the Children's Bureau is excited to implement what the General Assembly funded in 2014 originally referred to as the CPS pilot project. This provides key information to front line social workers Form a variety of data systems that we believe will ensure that those workers have more information to more fully asses children and families particularly safety related information, so that they will have that earlier on and in a more efficient manner. Some of that is available today But in very complex system navigation is difficult to have as timely as possible. So we're gonna implement what we're referring to as the Child Welfare Assist System Out starting this period as well. So moving beyond the actual core plan itself, I wanna talk briefly

about some areas that we are moving forward with the Governor's support in terms of what we think how we can execute the plan. As I talked Talked about, we want to improve performance through data quality and analytical capacity. So we were seeking three new state positions to help us take that qualitative data and again make it as quantitative as possible. But also leverage it across various Service components, so that we get a more complete picture of performance in a given county. We've talked a little bit about strengthening the child welfare work force. Again we wanna be competency based and tie that back to that data so we understand where additional supports and accountability might be needed And then the other part is to really make available effective services to maintain children in their own homes. A couple of examples, Triple P Positive Parenting Program, we have infrastructure here in North Carolina on Triple P. We'd like to request So additional investments in that. Currently there are more referrals for that service than are available. And we also have a national model of intensive family preservation services. And again the referrals and the requests for those services outstrip the availability to provide with given today's resources. Within the state functionality we know that timeliness to family foster home licensure is a challenge. we don't want the families who have generously opened up their homes for children, to serve children to have to Have to wait any longer than they have to. Currently that process is longer than what we'd like. And then if we could increase the efficiency by which we can get families approved, then they can be ready to serve children more readily. I've talked a little bit about how we needed to enhance our ability to provide technical assistance Assistance to county departments of social services. We also need to be able to better track and measure those improvements that we've identified. Again to quantify county outcomes and to aggregate that data up to a state level, is where we're headed in that. And then to enhance the training delivery system System, these seven new positions will be what I referenced as mobile training. They will respond to the jurisdictions where the need has been identified. [BLANK_AUDIO] Another area that is very sensitive and can tug at all of our heart strings is that we have a child fatality Review system here in North Carolina. Currently our capacity to timely review those desks/g that meet those criteria is not yielding the best results that we could. Requesting additional positions for this process will not only enable us to more timely Review the data/g so we can act more quickly to those circumstances but also ensure that all of the recommended system improvements are followed up upon. Today we don't have the oversight ability to make sure all are happening across the state Lastly I wanna talk a little bit about how the federal government is gonna measure North Carolina's improvement within the structure of the Champagne/g Services review. Again I wanna, I kinda empathize on that that the federal expectations center on the case review process Again notice the on sight review instrument. At the minimum we will be continuing with those same ten counties that form the basis last year that establish the review findings. We're proposing to the children's bureau that we randomly sample additional cases up to 100 across the rest of the State. Again what we really wanna emphasize here is that we want as robust a sample as we can and we want each county as many possible to learn from those review as possible implement the identified improvements that need to be made. That concludes my formal presentation. >> Representative Insco/g. >> Thank you Mr. Chairman. I wanna make just a comment and then ask some questions. So Happens when we have an economic like we've had since 2008 is that this program is like medicaid demands goes up.

You get more family violence more stressed families and referrals. And referrals if the referrals go up. So just at the time when our resources go down our need goes up. So it's really hard for our social services back home to keep up with the demand, and I thought really I'm glad to know that we were gonna focus on more training, I think that's really important. This was kind of a high level of presentation which was a good frame work to put the details on. But I wanted just to point out that one of the if you wanna prioritize a few things. One of the things I asked in an earlier meeting. Was about the increase in the case load. And I learnt that 75% of the people who are in this program all have the families at least 75% of the families in this program have a substance abuse problem. And so another problem that we have is linking our behavioral health services over to our county services. So we have 100 counties and now we have four. We are going toward four LME MCO's. I have some concerns about what brings about where there are LME MCO's are doing a good enough job providing services to our most vulnerable patients. This is the way market works this is a market system. So the providers are going to try they are gonna prefer the patients who were the easiest to serve they're gonna try to legitimately find a way not to serve the patients that are most difficult to serve, and so I think the one think we need to be able to do is to find out if we have 75% of our families in child and family services. And they have substance abuse problems, we're not linking those two systems well enough. So I guess part of my question would be, again you had that as one of your goals here, better linkage between the NCOs, what could we do to I guess support you as you do that? Do you have some ideas? >> Thank you for the question. I can't give you any specific ideas at this time, because what the plan calls for is to engage at the LME CEO level with the The countries in that agencies catchment area to identify those areas and specific performance measures that we went to establish, and track as we move forward. I think after that process the barriers to executing that will be perhaps where this body could help us out. Just one follow up. This is probably a comment also. So the other piece if evidence that we have, the LME NCO are not addressing all of it patient need is the fact that we have so many people with no health problems, and addiction problems in our jails and prisons. So there's a gap somewhere between, we're cutting the fund balance from the LME NCOs. May be what we need to be doing is to identify the gaps and services at the local level and make sure that those if they have If they're saving too much money they're not spending that they need, then we need to figure out why they're not spending the money on the services that are clearly needed both by our social services programs, and just [INAUDIBLE] more appropriate people in our jails and prisons. >> Thank you representative Insko. >> Senator Pendleton. >> Thank you Mr. Chairman. On slide or page 21 we're talking about current 14 new people. I hope you all will give consideration to hiring them locally across the state geographically and not housing them up here. Cuz got enough state employees in Wake county, and that way you try to save a lot of money on travel expense, you could house them in a county social service office or let them work on their home, but I hope you'll consider doing it. >> Mr. Kelly >> That's exactly what we have in mind for all of those positions as they will be stationed across the state for that very reason, thank you.

>> Representative Murphy. >> Thank you Mr. Chairman. Just have a few actually statistical questions and I'm not quite sure they're gonna be right at your forefront, but what are our success rates of placing children from foster care into permanent care? How are those trends going in the last five years, and are they age related? In other words I would assume they would be that it is easier to place a 4 year old than it is a 15 year old. Just interested I have a few statistical questions, do you know the answers to that by any chance? >> Mr. Kelly. >> I'm sorry, what I'm not sure I understand the question, are you asking how quickly we can get children into permanent homes after they are brought into the foster care program? >> Correct. What are How efficiently and how successfully are we at placing them into homes in a years time for example. >> Right. Thank you for the clarification. Actually that's part of the aggregate item measures under permanency one that I spoke about. North Carolina does not meet what is referred to as the national standard for achieving permanency within 12 months. So the goal is obviously always to get children onto permanent homes which may be return to their own home. I believe that's whenever possible our first desire and option. We do not meet the national standard of achieving that rate within the first year, but we do then catch up to the nation in achieving permanency in the subsequent measures which look at how well and how quickly we can establish permanency for children first within more than 12 months, but less than 24 months and then greater than 24 months. We Hesitate to see any child day in the foster care program for that period of time, and I think you are absolutely right that the older a child is the harder it is to achieve permanency. I didn't speak on this but one of the goals has a strategy that will look at what is in our industry we refer to Diligent recruitment and that is really seeking families who can match and met the needs of the children we see in the program across that state and one of the areas we know we will need to target are not only older children about 12 and over Seems to be a critical time where permanency becomes very very difficult. To chip timely, sibling groups has always been a challenge for us as well and then tying back to one of the other outcomes, the one of the various that we see and achieving permanency, is a child who obviously has experienced a significant amount Significant amount of trauma, has those behavioural health needs as well and addressing those needs is critical because as you can imagine these children are very difficult to care for and getting them into a permanent home often means, mitigating those traumatic behaviours. >> Follow up. Okay, so we don't need to stand the national guidelines or levels. What are we now and what are the national ones? [BLANK_AUDIO] >> We can get you the specifics. I will speak briefly, one of the challenges that we have Working with the children's bureau is that, first we have some data quality issues that have to be addressed. So I spoke about our performance on those data indicators at the present time, the children bureau doesn't consider them valid. So before we can achieve from the federal Federal government's perspective these items first of all we must address the data quality issue. >> Okay, thank you. >> Representative Farmer-Butterfield. >> Thank you, Mr. Chair. I wanna thank you for the excellent presentation. It was very succinct and outlined to the point. I appreciate it. I'm going to ask you about the same issue Around Representative Insko with the behavior health and the child welfare system working together. Two things come to mind. One is will there be any kind of local or regional interagency leading us with all the stakeholders periodically to make this happen? Is this something you've talked About or thought about? Or is it even possible with the [UNKNOWN]? >> Mr. Kelly. >> Thank you for that question. Yes, that's absolutely our plan. We've actually began to outline a structure for that very effort. Again what we want to do is have It at the LME/NCA level so that all counties in that catchment area will not only participate but agree upon what are the performance measures and expectations we wanna establish at that LME/NCA agency

level. We expect that to transpire Over the following year and possibly into the second of the plan period. >> Excellent. >> Follow up. >> It's the state office going to have any kind of agreement, intergency/g or interoffice agreement, between the Division of Mental Health and the Division of Social Services in this regard >> thank you also a great question. Yes. That is exactly the plan since all of the agencies are under the DHHS umbrella and I will add the Division of Medical Assistance to that mix as well, and the Division of Aging and Adult Services will be participating in that for a couple of reasons We feel that they may need the LME/MCO system as well. And so we're working across four different divisions under DHHS. >> Then this is an excellent plan. We look forward to seeing the following results. >> Thank you, Representative Farmer-Butterfield. Representative Insko? >> Thank you, Mr. Chairman if you look at page 5, as we were going through this presentation, it struck me that this program really has at least three target populations you work with. You work with a children, but you also work with the original families of the children and you work with the foster families. And that's true for safety number two is focused on children and I guess safety one refer safety two but almost all the others are talking about the families that they are in. So I'm curious about the kind of services that you provide to the, and permanency in their own families is, I think it's state's policy that's our top priority that a permanent place as soon as possible but priority with their own family if possible, what kind of services do you provide to the families, just sort of help a child reintegrate and how do you work, what are the barriers, what are the challenges you're working with the new foster families? Is it just a training process? How do you actually go about providing those services to the families? >> Direct to Kelly. >> Thank you. That's actually a very complex question to answer. What I would say first and foremost is it's based on the assessment of the family that we're working with whether it's the birth family or in some cases the substitute care family. And really an emphasis has to be placed on that the services are individualized based on that assessment. We do see themes we've talked about substance abuse disorder is frequently found. Other mental health related issues are found, and then I've talked briefly about a couple of programs that we have invested in and we found very effective across the top population. PPP, I mentioned is a model that looks at and has multi-layers based on the intensity of the need of that family. It can be some basic parenting, skill building or it can be much more intensive up to level five. That helps to individualize the services to meet the parents needs. Intensive family preservation services is exactly what the name suggests. It's based on what is referred to as the home builders model. And that model again used across the nation has a variety of techniques to help parents understand the needs of their children and how they can better respond and interpret the behaviors of their children so that they're able to care for their children. I think the bottom line answer is that the services are depended upon the adequate and full assessment of the parents needs. >> Follow up? >> Follow up. >> So you write some of this training or you provide some of these services through your own workers and you also depend on other agencies like the LME and [UNKNOWN] to provide some services. So you're workers really have to be highly skilled people, and I'm curious about your turnover rate or your direct service turnover rate if you have any information on that. Whether it's higher in some counties than others. >> Thank you. That's exactly right. The services are really provided across an array of providers sometimes directly by the county. Social worker often brokered through various commute partners and that does vary Does vary across the community by community. And I couldn't agree more that that requires a high degree of skill and investment of time to first of all acquire the skills and then as you can imagine to execute the effective services requires a

great deal of time Traditionally and predominantly in the home with the parents often in a where we refer to as the natural setting, you can better practice parenting skills while parenting in your own home. So there's a huge investment in normally skills but time there as well. The turn over rate we continue to monitor There are some discrepancies across the states I don't have numbers in my head. What we see and what we struggle with is often times what looks like you know, there's good turnover and there's bad turnover. Good turnover can be where a social worker gets promoted to be an effective supervisor Here to help new workers build there skills and capacity. That's often accompanied by movement across county lines. So what hurts one county may help another county. So being very careful and looking at the turnover not a just as a rate which hovers around 25% across North Carolina but also digging a little deeper into figuring out what the turnover rate means at the agency level. >> One more follow up. >> Follow up. >> How much does it cost you to train a new worker? >> Also a question, I don't know that we have sufficient information to get our heads around, I think it really depend s on how that worker comes to us. If they have an MSW degree it's probably much more efficient to give them up to their skill level that we need. If they don't have that educational background then Then probably it would be much more expensive. I think what we need in order to drive a better answer to that question is ability to assess a workers capacity and skills set so that we know when they have achieved a reasonable level of skill and therefore measure what it costs to get into that That level. >> That's a pretty high turnover rate. We could save money if we could somehow I guess hire more trained social workers or find a way to keep People get it up to the level of training where they are more comfortable with their work or some way to cut down on the cost of training new workers all the time. >> Thank you. Mr.Kelly, I know that you said, state performance in the third round of the CFSR Are as not directly comparable to it's performance in the second round. No, it's not directly comparable and I know it was 2007 when was our last review, if I'm understanding this correctly. Would it be fair to say in your subjective or objective opinion that the trajectory is at least in the right direction between 2007 and now based on The two reviews. >> I wish I could say that what respond two ways first of all and confirm with the children bureau is that between the second round and the third round they increased their capacity to assess. All jurisdictions North Carolina and again in some instances intentionally raise the bar to what they would access as substantial conformity on any of the outcomes or systemic factor. Setting that aside, It would be I think the general opinion. The professional across North Carolina that been 2007 and 2015 the trajectory was towards the negative. >> Thank you. Do we will their be a forth review or will his OSOR take. Take the place of that forth review and will the standards be the same. Or do we know since it's feds the federal government. >> I can't speak for certain because yes you are right it is the federal government that every indication their will be a fourth review. Probably some additional changes made but the basic review process. Probably remain in place and that's why we want to honor and continue use of the federal proc that are prepared for that forth round once it counts. Do we have an expectation of when that will be, in this review? >> No no. Help to eliminate a little bit of that one of the if you do the math between first and second and second and third, they are actually slowing down. My experience with that is it was depended upon the commissioner for the children bureau the federal level.

The prior commissioner wanted to make even more changes. Changes to the review and therefore took more time between round two and round three. That leadership has turned over. Who knows what the future will hold and what their leadership will decide. After completion of the third round for all jurisdictions that takes four years in it of itself So waiting to see and they will undoubtedly wanna take another assessment of all jurisdictions and feedback from all states to see what future changes might need to be made for round four. >> With these new golas that we've got in place or we're confident that we can change Change that trajectory because from 2007 to now, that's been nine years. Are we confident with this new plan, with these new goals going forward that we can at least change the trajectory from down to a positive result. >> I think the The activities and what we've planned for the two year period is a star. I think we will need to continue to look more broadly at our system and develop a more strategic plan in order to be fully prepared for round four. As I've mentioned, we have to Write the plan for a two year time frame. I think everyone in the field would agree that if you really want to make real system changes, you're gonna have to think obviously more broadly and also over a longer period of time to see the kind of improvements from workforce to infrastructure that need to be made. >> Thank you. That's something definitely the legislature would like to play a role in. You wrecking/g off. >> Thank you for the opportunity to follow up. I'm sure your bracher/g Deputy Secretary for human services. While the review does not show some of the investments that we have made up for the course of the last couple of years. This body and our agency, there are number of things that we've already invested and we just don't have the data yet to show the improvements that some of those investments may have made. For example, your investment into the case management system for child welfare, we don't see that is part of this review but that was an effort that started last year. We also increased a number of child protective services workers in the state and we don't see the impact of that as part of this review. So Kevin is right, the data doesn't show the improvement but what we do know is that some of the investments that were already have made and are making are gonna move us in the right direction. I think the other thing to realize is the program improvement plan is a very narrow look at specific foster care and adoptions but the continuum of child welfare services reaches far beyond just those two areas. There's the child protective system and there's more of the end home services and some of the prevention services and we've also made investments there and as we make those investments while not articulated in the program improvement plan they are gonna help us move the mark on this outcomes. >> Thank you, thank you. One last question. And I think that's the goal of all of us I'll just this that to at least move in a positive direction from where we were in 2007 going forward and hopefully some of those investments and I'm confident that they will, will be reflected later and continues that communication, that dialog to make sure that we're going in the right direction. One last question on slide 23, the on site review instrument to be used in ten counties who have built the capacities review cases in accordance with the federal expectations, are those 10 counties more urban counties, more rural counties, is it a division of the three, I'm sorry the two, what's the makeup of those 10 counties? >> Thank you for the question and I'll refer back, I listed them somewhere. What I will say is we intentionally found our three very large urban counties Mecklenburg, Wake and Cumberland county in terms of foster care are the three predominant counties in North Carolina and that was strategically. We also wanted to include some of the small counties trying to be as geographically dispersed as we could but also incorporating a couple of counties that have what we refer to as special populations, native Americans, American Indian down in the Scotland Hoke area that was intentional The development of Eastern Band of Cherokee Indians to be their own agency has made a little bit of shift in this between the actual review in 2015 and that they are approved by the federal government they will have a child and family services review presumably in round four.

Obviously we wanna continue to partner with them because, well, they want to serve theirs.We also know that population,We'll also continue to be served by the state's system of Child Welfare Services. And I think that's a good thing, the broader we can make it so we have a clear picture of North Carolina and those review. And it sounds like that's what you're doing there across the board. I just wasn't sure those more rural counties would have the capacity to do that. But it sounds like, if I'm following you correctly that some of them at least do. So they're included in that ten for the review. >> Correct. Some of them do. One middle new one so wanna point out that the protocol of that case Case review requires a very high level of whether Children's Bureau referred to is a conflict of interest policy and they interpreted that to me. Any individual who knew that the family was reported from the time they reported on if they knew the name, they were excluded from being eligible to be part of Part of the case review itself.And having worked in a small county,I can tell you in some of those small counties everyone knows everyone's name.Maybe before the report, but certainly at the time of report.So what we've done and we wanna give good credit to the counties is that they partnered with each other, so that the representative For example from Scotland county we'll review, the whole county case and vice versa.That was also true in Wilson county, and they've partnered both with Ted and actually Bangor to help them review that in accordance with the federal expectations. And we continue to see that need moving forward. [BLANK_AUDIO] Thank you, thank you, thank you for your comments. One last question for representative Insko/g and we'll adjust. >> Thank you so we talked about the coordination with the eleminias/g CO's. I'm curious to know whether you have, what kind of relationship you have with our public school system so I know that Doing some work with Bill Hussey/g about child and family teams but that's the reeducation model where you actually try to build on the strengths of a child and engage churches or crotches. Some to actually try to build on the strengths on a child of a family. >> What is your relationship with the school system? Thank you for that question. Fortunately, two days ago, we actually got to meet with super attendant, [UNKNOWN] and the fact Secretary Brazer /g was their as well. So at a very highest level, but also in a regular basis, with the individual that you mentioned We participate in the School [UNKNOWN] health initiative. We participate in a couple of other venues we can partner, not only with the school system but really other child serving systems that cross the [UNKNOWN] The Department corrections Juvenile Division. That individual an I know each other very well so We're, I think, on the right path to partnering with the school system and made a commitment at the very highest level to continue quarterly meeting at the executive level to make sure we can monitor our progress. >> Thank you and I'm gonna quickly say one last question because I've always I've always got one more. Do you anticipate more funds next year since this is a two year plan? Or do we have the funds adequately now or do we know yet? [BLANK_AUDIO] >> This is Sherry Bradsher/g Deputy Secretary for Health and Human Services. I think what we've We've outlined in the short session as far as our budget [UNKNOWN] around the program improvement plan gives us a very very good start. The final plan once it's approved there may be some nuances and other things. We've had a number of opportunities to evaluate our child welfare system, not just through the program improvement plan but we're getting the results back from the In the monitors that you gave us a couple of years back. All those reviews are coming in.We also had the CPS pilot evaluation which we presented to you at one of the Yellow C meetings.What we wanna go back and do is take all this information that we have from all these various resources and strategically lay it out, so that we can determine what are What our next steps are to improving and then enhancing the child welfare services. I say all that to say without a doubt, with the OB addictions and all the other things that we're seeing as ever changing, there will be future ask in order to show up our child welfare system and create the infrastructure that we need to make sure children are safe. >> Thank you Please convey to the secretary in you all your time today and appreciate how presentation and the direction that we're going. I appreciate it and appreciate you're all taking the time to be here today. Members thank you for your attention and your questions. At this time we will stand adjourned. Thank you.

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