In the beginning of 2004, the tragic death of a young boy in San Antonio, TX raised concerns about Texas Department of Protective and Regulatory Services’ (TDPRS) procedures relating to the investigation of the child protective services (CPS) process, including responding to telephone reports and assessing the risk of maltreatment accurately. TDPRS is currently under investigation ordered by the Governor, Rick Perry. The Governor stated, “there is enough evidence from various parts of the state to suggest that some of our most vulnerable children are not receiving the protection they need from abusive situations. The evidence leads me to believe we have a systemic breakdown in the safety net that must protect abused children” (www.governor.state.tx.us July 1, 2004).
This paper examines current procedures in the investigation process and provides recommendations for improvement related to several of the details and feature of the operations process. “Reinventing government” initiatives draw heavily on supply chain management, total quality management, business process reengineering, and just-in-time delivery – concepts that fall under the Operations Management umbrella.(Chase, 2003). Because this review is narrowly focused on the CPS investigation process, there are several essential elements of child welfare services that are not addressed in this paper, including substitute care and permanency services.
OVERVIEW OF FUNCTIONAL AREAS
The overall goal of CPS is to protect the unprotected children from abuse and neglect. This report focuses on specific CPS functions and crosscutting themes. These functions are those that comprise the child protection response to allegations of abuse and neglect. Operational definitions described in this report include:
* Screening and Intake – the process by which CPS receives a referral and a report concerning allegations of child abuse or neglect, and decides whether or not to respond to the referral and report.
* Investigation – the process by which CPS determines whether child maltreatment has occurred or if a child is at risk of maltreatment, and the decisions and actions that are needed to ensure the child’s safety.
* Other CPS Response and Alternative Response – a response to an allegation of abuse or neglect that assesses the needs of the child or family with or without requiring a determination that maltreatment has occurred or that the child is at risk of maltreatment for the purpose of providing the family with services.
For each function, there are several different features. The workflow of these functions is described in Table 1.
SCREENING AND INTAKE
Receiving community referrals, which includes those from mandated professional reporters and the population at large, is the gateway to CPS. Features of the intake procedures include the availability to receive reports, methods for documenting reports, and timeframes for accepting and forwarding a report. Intake is available 24-hours a day 7 days a week, and centralized in Austin, TX. Referred reports are generally categorized into two groups.
In the first group, CPS caseworkers are dispatched immediately for children believed to be in imminent risk of harm. In the second group, investigations are usually initiated within 10 days. The policies indicate that a decision protocol for forwarding cases for investigation. The hotline workers conduct quality assurance (QA) reviews on each case and decision to forward a case to investigation is made with supervisor approval. In case of sexual abuse and serious abuse, the case must be notified to law enforcement.
The investigation function addresses the process of determining whether a child has been maltreated or is likely to be maltreated, and if services are needed to ensure the child will not be harmed in the future. TDPRS implemented the use of risk and safety assessment (IRA) as tools to guide decision-making as to when and how to intervene to keep children safe in the immediate future and to reduce long-term risk. The result of IRA was included at case closure, during case planning at any major decision point, or whenever circumstances suggest a child’s safety is at risk. Investigators usually check if the child’s family has had a prior validated report of abuse or neglect. Investigators then visit and interview the family, including initiating face-to-face contact with the children, and begin collecting information about the alleged maltreatment incident.
If an investigator, during the initial investigation, believes that a child has been maltreated and needs the court to protect the child’s safety, the investigator must initiate judicial oversight of the case, which can be time-consuming and complicated. While the investigator is following the procedures involved in investigating the alleged maltreatment, he or she is also developing a tentative plan to address those conditions in the home that CPS believes contributed to the maltreatment of the child. This plan ultimately becomes the case plan that outlines treatment services for the child and the family. The plan described what actions are required of all the parties involved to correct the condition that caused the maltreatment.
OTHER CPS RESPONSE AND ALTERNATIVE RESPONSE
The overall goals of alternative response are to provide a response option to those families whose situations did not meet the mandate or criteria for CPS involvement, to serve low-risk or low-severity situations, or to improve family situations. This is to emphasize partnering the families with the community and creating a network for the family, protect children and assist parents to recognize and remedy conditions harmful to their children, provide preventive services before the need of CPS involvement is required, and prevent the family from potentially being re-referred. The causes of child abuse and neglect are complex, and a case plan can involve referrals to an array of individuals, including caseworkers from other units in the agency, private service providers such as mental health and counseling professionals, other public agencies such as housing and transportation services.
Documenting business process flows visually not only helps in ISO and QS initiatives, but it is the first step toward continuous improvement. (Gould, L. 2000) A good way to start analyzing a process is with a diagram showing the basic elements of a process (Chase, 2003) Table 1 describes the overview of current workflow from the time the report of maltreatment was reported to CPS until the completion of the investigation.
Because child protection is a critical service and because of the seriousness consequences of errors, CPS must seek to insure the quality, timeliness, and accuracy of the process both through detailed specifications (laws, regulations, and policy) and thorough supervisory oversight. However, the process must be balanced with systems that give workers and supervisors sufficient flexibility to apply sound professional judgment. Increases in the number of maltreatment cases, the changing nature of family problems, and long-standing systemic weaknesses have placed the CPS system in a state of crisis and undermined its ability to fully carry out the responsibilities for abused and neglected children.
First, child maltreatment reports have risen steadily across the state. The caseloads of CPS have grown correspondingly, and CPS cannot keep pace with this workload. Second, these caseloads are increasingly composed of families whose problems have grown more troubling and complicated, with substance abuse a common and pervasive condition. Finally, systemic weaknesses, such as difficulty maintaining professional and skilled workforce, inconsistently implementing policies and procedures, and poor working relationships with outside resources has created a long-standing problems. The combined effect of difficult caseloads and systemic weaknesses may endanger the lives of children coming to the attention of CPS.
In CPS, the staff sometimes deal with life-and-death issues, the knowledge of and consistent application of appropriate policies and procedures are critical. However, CPS staff is unable to consistently apply existing policies such as inadequate safety assessment. This is because policies change frequently, no procedures manual exists, and information is inconsistently distributed to all staff.
By necessity, CPS should work efficiently and effectively with outside resources to protect children. However, the outside resources, like CPS, also face problems associated with the large volume of increasingly complex cases, budget cuts, and Medicaid reform. Unnecessary time spent to transfer or refer cases diverts the investigator from performing investigative activities on other open cases and create “congestion” in workflow.
COMPARE AND CONTRAST WITH OTHER PRACTICE
In 1994, Missouri developed a new strategy to handle the overwhelming number of reports coming into its CPS system. Missouri recognized that state government, acting alone, had neither the resources nor the local community, neighborhood, or family base to effectively alter the cycle of abuse and neglect. The agency and local CPS offices have turned to the broader community of churches, schools, mental health providers, and others to expand their reach.
By developing partnerships with these community groups, CPS is able to quickly increase the number of people available to serve children and their families, without increasing CPS staffing levels. The model in this state is also based on the premise that not all CPS cases require the same traditional approach. Instead, the models incorporate a flexible response, whereby CPS cases can be grouped according to the nature of the allegation, recognizing that different types of allegations required different responses.
Build Community Partnership
Different types of maltreatment require dramatically different prevention and treatment strategies. It is critical for CPS to form partnerships between CPS and community service providers. This will allow the cases to be referred and transferred more smoothly and in a timely manner. However, ultimate success will depend on the CPS staff’s ability to overcome certain challenges, such as developing willingness within the community to become more active in protecting children from maltreatment and to adapt to new roles and responsibilities.
Refine the Key Performance Requirement
Key Performance Requirements
How to Achieve These Requirements
* Community awareness of when and how to report
* Minimal wait to reach the intake workers
* Effective use of the CAPS (agency computer system)
* Enhanced phone system that provide real time information, manage call distribution to available workers, and support estimation of staffing requirements
* Immediate response to high risk situations
* Reasonable timeliness of decisions on other situations
* Sound screening decisions
* Screening guidelines that provide consistent direction
* Immediate access to relevant information system
* Real-time consultation from experienced supervisors
* Sufficient thoroughness; reasonable and prudent efforts made to obtain relevant information
* Timeliness of decisions
* Decisions consistent with information and with policy
* Assessment guidelines that provide consistent direction
* Assessment timeliness requirements that balance thorough information gathering with responsiveness
* Reasonable caseloads and adequate number of staff
* Accessible consultation from experienced supervisors
* Information that enables management to make sound judgments regarding overall performance and other matters, such as staffing requirements
* Information that enables supervisors to manage caseloads and monitor quality and timeliness
* Use of the information to identify targeted improvements where needed
* Real-time information about on-going cases
* Reports on both the detailed (by worker) and summary (by unit) level on caseloads and case status (pending, deadlines, overdue, etc.)
* Reports of quality assurance findings
* Designation of specific performance measures that will be tracked and monitored with comparisons across local offices
* Management reports on overall program performance including workload, timeliness, quality assurance results, investigation outcomes, list of outside resources, etc.
TDPRS is facing increased reports of child abuse and neglect, as well as a disturbing increase in the number of families with severe and multiple problems. The burden to improve the ways CPS responds to children at risk of abuse and neglect falls on state and local governments. When a process is operating at capacity, the only way to take on more work without increasing the waiting time is add more capacity (Chase, 2003) CPS management must recognize that the traditional approaches to child protection cannot keep pace with the demand for services.
CPS needs to reach out to communities to establish partnerships among service providers, as well as our citizens. Furthermore, the CPS management team must look at the entire workflow of the operations process and recognize long-standing systemic problems. It is critical to seek ways to correct deficiencies and to build and maintain the personnel that will support the operations management strategies.
Chase, R. (2003). Product design and process selection. Operations Management for Competitive Advantage, Tenth Edition. The McGraw-Hill Companies.
Chase, R. (2003). Operations strategy and management change. Operations Management for Competitive Advantage, Tenth Edition. The McGraw-Hill Companies.
Gould, L. (2004) Designing a better business. Gardner Publications, Inc. Retrieved from www.autofieldguid.com on 8/23/04
McDonald W. (2001). National study of child protective services systems and reform efforts – Literature review. Retrieved from www.aspe.hhs.gov.hsp/protective01/