![Exhibit 6.1 Child Abuse and Neglect [CAN] Referral.](fig6.gif)
[ Main page of Report | Contents of Report ]
The reforms instituted in La Crosse County, Wisconsin, were not the result of a single initiative. Rather, they resulted from a convergence of several State and local efforts. The reform efforts addressed two main areas of change — easier access to the agency and more efficient identification of the services needs of children and families. Several ongoing State initiatives, some of which started before the reform period, were strengthened to support these changes. These include caseworker training, the use of the State's risk assessment model, and collaborative efforts to provide services to children and families.
During 2001, the La Crosse Human Services Department (LCHSD) consolidated all children's services into the Family and Children's Services unit. While this was initially a fiscally-driven decision to consolidate services and maximize reimbursement by title IV-E and Medicaid funding, it enhanced access to services by needy children and families in the community. This reorganization has led to the current structure of shared investigation and case management roles within the unit, but with each worker having a defined role for each case.
Wisconsin is a county-administered, State-supervised system. The LCHSD is responsible for CPS in La Crosse County. The LCHSD has five sections — Operations, Long-Term Support, Economic Support, Clinical Services, and Family and Children's Services. The Family and Children's Services unit has primary responsibility for providing CPS, juvenile services, and services for children with disabilities.
The three CPS units each include one supervisor, intake staff, investigators, and case management workers. The supervisors rotate responsibility for intake each day and supervise investigative and case management workers. Supervisors attempt to keep the cases within the same unit from investigation to case management; however, this is not always possible.
One of the three CPS supervisors also manages the Integrated Services Unit. The Integrated Services Unit serves emotionally disturbed children at risk of being removed from their homes with a goal of assisting parents in maintaining the child at home. These cases may be under court order as a result of an abuse or neglect referral or may be voluntary. During 2001, 25 families were enrolled in the program; during 2002, children from 23 of these families were still living at home.
Exhibit 6.1, Child Abuse and Neglect (CAN) Referral, illustrates the movement of a case though the CPS System. Child neglect presented 45 percent of all calls during 2000 and 2001, or more than 400 reports each year.
Exhibit 6.1
Child Abuse and Neglect [CAN] Referral
[ Go to Contents ]
Over the last few years, La Crosse County has seen an increase in referrals. By the end of August 2002, there were 1,500 cases, which was the typical annual total. Caseloads increased from 10-12 to 17-19 new cases per month. Workers reported an increase in the proportion of families with multiple problems — mental problems, alcohol or drug problems for adults and children, and physical handicaps.
Both CPS and the court representative identified an increase in referrals to the agency, but a decline in court referrals. Supervisors and caseworkers alluded to the increased paperwork and rigid timeframes as reasons for staff to avoid a placement. Avoidance of placement would be a positive outcome if alternative interventions were identified for families; however, it would not be a positive outcome if the safety of the children was compromised.
In order to balance workers' caseloads so that no one worker was responsible for too many difficult cases, a case-weighting matrix was developed. The county expects that the new Statewide Automated Child Welfare Information System (SACWIS) will include a case-weighting capability to achieve the same objective.
CPS Organizational Changes
Prior to the reform changes, the Family and Children's Services units were defined by function — intake, investigation, and case management. The new director made the units generic, where workers share responsibility for intake, investigation, and case management. After some confusion, roles were specified for each worker. Delinquency is maintained as a separate unit.
Use of Paraprofessional Staff for Intake
When fielding calls for assistance to seniors, the agency found that social service paraprofessionals could handle the phones and referrals, relieving the social workers who previously covered the phone intake. Since the end of 2000, social service paraprofessionals have been responsible for speaking with callers and recording screening information on an "access sheet," which is forwarded to the unit supervisor. The access sheet uses the Wisconsin Risk Assessment Model. The intake worker receives information from the paraprofessionals who have used the risk assessment protocol. The supervisor then determines if the case is screened out or not. If the case is not screened in, a decision is made as to the appropriate response time.
Practice Changes Initiated by the State
Several State initiatives, in which the county participated, contributed to the reform efforts. The activities included the implementation of risk assessment, core training, and domestic violence best practices. (Those initiatives are described as part of the reform because of their importance as indicated by the staff.)
It was agreed that the first objective of CPS must be to protect the safety of the child and the battered parent. Safety for the mother includes ensuring the confidentiality of information collected by CPS and refusing the batterer access to her location. During January 2002, the workgroup issued a document entitled, Mutual Respect and Common Understanding. The workgroup recommended training for domestic violence staff in the CPS system, development of a memorandum of understanding between local domestic violence and CPS agencies, and revisions to the CPS investigation standards.
The Domestic Abuse Reduction Team (DART) was established in the county. The team includes representatives from CPS, the police, and domestic violence. After three reports of domestic violence, the DART will visit the family and automatically arrest the batterer. A DART case is opened, and random home visits will be conducted. As a result of the reform, all DART cases with a child present are reviewed by a CPS supervisor.
Results from the La Crosse County reform efforts, as identified by the interviewed staff, are described in the paragraphs that follow.
Better-Trained Staff
Core training and risk assessment training resulted in a better equipped CPS staff who use the same terminology and concepts. The training has also fostered a strengths-based family focus.
Improved Case Review
Directors and supervisors have observed a better review of cases by caseworkers and their colleagues. The change was attributed to the reorganization of the unit as well as training. The reorganization has allowed most cases to stay within a single unit from intake through case management.
Reduced Use of Expensive Placements
The directors and supervisors attributed the reduction of placements to the reorganization of Family and Children's Services and the CPS unit. Prior to 1999, the Alternate Care Resource Unit was created to reduce the use of high-cost institutional placements and to keep the children in the community. The unit has been successful in reducing the number of out-of-State placements and has resulted in the county being under budget for the first time in more than
20 years. In addition, the Integrated Services Unit, through voluntary and court-ordered services, has developed expertise in giving wraparound services to families of special needs children.
Decisionmaking by Workers
The directors and supervisors reported that the core training and the use of the risk assessment model have resulted in better decisionmaking. These activities have improved opportunities for interaction among supervisors. The family focus has changed the adversarial role for workers, resulting in improved relationships with foster parents. Foster parents have become vital team members who help birth parents prepare for reunification.
Mediation of Complex Cases
The court administrator identified the Unified Family Court as the most significant court improvement during the past year. Through the Unified Family Court, if a family is identified as having multiple issues — CPS, custody, criminal, or domestic violence — one judge leads and mediates all issues concurrently. Three of the five judges originally participated in the project. Within the prior 6 months of this interview, all judges had joined.
Faster Case Transfer
The State initiative to respond to the Adoption and Safe Family Act (ASFA) has helped to create more efficient and faster decisions for children and families. The changes have been primarily for case management workers. Once assigned, the workers have 10 days to make the first contact and 60 days to complete a plan.
Intake has been affected by the change in the transfer policy for cases. Ongoing cases are assigned before the disposition of the investigation. While the timeline for the case management worker does not begin until the disposition, advance assignment enables the intake and case management worker to collaborate on service planning.
[ Go to Contents ]
Conditions that have supported or sustained the reform efforts in La Crosse County are described in this section. Future plans of the County with regard to reform are also presented.
The department has been participating in several collaborative activities for the purpose of sustaining reform efforts.
Family and Children's Collaborative
The Family and Children's Collaborative has set many ambitious goals for collaboration between State, county, and community agencies. The collaborative has been exploring the development of a cabinet to consider case management issues and maintain a common vision among stakeholders. Objectives include activities to deal with such community concerns as short-term planning for truancy and curfew problems.
CPS Citizens' Review Panel
The Citizens' Review Panel began meeting to review CPS issues. The judges took leadership of this process. The panel includes representatives from CPS, law enforcement, the District Attorney, County Counsel, schools, and hospitals. On October 1, 2002, the panel began reviewing sample cases and fatalities to understand the CPS process.
Training
The county attributes implementation of a core curriculum for the training of all new workers and retraining of all current workers as a support for the new reform efforts. All line staff, including supervisors, must have a bachelor's degree. The director and supervisors considered the core training as the major change during the past 2 years. A 6-month curriculum has enabled workers to use common terminology. This has resulted in more case reviews, heightened accountability, and better decisionmaking.
The department director described four areas for future activities. They include a managed care initiative, alternative response, the implementation of SACWIS, and "raising the bar."
Managed Care Initiative
The county anticipates that a managed care contract will be in place in the future to provide services to high-risk children. All children at risk of placement in a residential treatment facility will be included. In addition, a risk pool will be created with 10 other counties. The chosen vendor will provide services in the community with a capped amount of money for each child and an incentive to keep the children in their own homes.
Alternative Response
The county is exploring alternative responses for cases with a lower risk of abuse or neglect. Assessment and case management will be contracted out to a community-based agency. The county is exploring a model for use by the end of 2003.
Implementation of SACWIS
The county is scheduled to implement WI SACWIS, the statewide child welfare data system, during 2003.
Raising the Bar
Presently, the volume of new cases continues to increase. Concerned about State cutbacks and the impact of increased volume of referrals, the county has been looking for ways to raise the bar. This would mean changing the threshold of who receives county services to only those at greatest risk or those for whom actual harm has been documented. The county has begun to screen out subgroups of cases, for example, referrals of physical abuse with no marks present. Similarly, calls regarding sexual touching between two children age 6 or younger and mutually consenting sex between older teens (age 17), are also being screened out. These changes are of concern for some of the workers and supervisors.
[ Go to Contents ]
The reform initiative in La Crosse County, Wisconsin, was an attempt by the department to improve access to the system, to match services and client needs, and to ensure that maximum Federal reimbursement was maintained. The reform was actually a compilation of smaller activities over a long period of time. These activities included the use of paraprofessional staff for intake, a combined CPS unit, and domestic violence screening. Now, in the context of an increase in the volume of referrals, the department is exploring ways to raise the threshold for accepting children and families who must be served. The department is attempting to balance shrinking resources during a time of increasing service needs.
Top of Page |
Contents
Main Page of Report | Contents
of Report
Home Pages:
Human Services Policy (HSP)
Assistant Secretary for Planning and Evaluation
(ASPE)
U.S. Department of Health and Human Services
(HHS)