THE OFFICIAL MEETING NOTICE CAN BE FOUND ON THE CAPITOL WEB SITE: http://www.capitol.hawaii.gov/

1. Welcome and Introductions
2. Department of Human Services Update on Hawaii’s Welfare Reform Efforts, including but not limited to Child Care and Demographic Information
3. Discussion of Potential 1999 Legislation
4. Next Meeting: To be announced
5. Adjournment

The purpose of the November 3, 1997 roundtable discussion was to look at the Child Protective Services (CPS) system to identify problems and needed changes, and to find solutions to these problems. To facilitate this process, attendees broke off into small groups and discussed one of four issues:

Improving Foster/Adoptive Care & Prevention, Policy/Decision-Making, Professional & Program Resources, and Reporting/Investigations-Data. The following is a summary of each small group discussion.

Duplicative comments and solutions among each of the four issues are kept in tact to reflect the context of the small group discussions. Italicized print represents comments and bold print represent solutions.

• At Kapiolani Medical Center's Foster Care Services:

• 67% of children under 3 have developmental problems; and

• 64% of children older than 3 have mental health needs.

As managed care takes over; it may become more difficult to access services.

• It takes too long to get medical records from one provider to another (although this is true for more than just foster care).

• A comprehensive medical center is needed in the community, not just

at one central location (such as Kapiolani Medical Center).

• Establish a "Medical home".

• Foster parents should be allowed to give consent for immunizations, emergency care, and medical records. Change the legal status of foster parents.

• Enable foster families to put foster children on their own medical plan or put all foster children on only one provider such as HMSA Financial and social costs are minimized if children get the care they need (medical and mental health) up front than down the line).

Children who stay in care for years become unadoptable.

• Recognize the child's sense of time. They can't stay in limbo: they're basically "homeless".

• Appropriately match the child with the home to enable the child's needs to be met.

• Fully inform foster parents of the child's history and needs.

• The statute requires that we look at adoption first, then guardianship, and finally long-term foster care. Does this need to be changed?

• There are approximately 1,100 foster homes currently in the state.

• Concurrent planning - is it happening? This type of "risk adoption" requires a great deal of training for positive outcomes (reunification or adoption).

• Biological parents still have legal rights after their child(ren) are removed from the home. It is unfair that the state becomes financially responsible for these children while their parents still have legal rights.

• Break down barriers for adoption.

• Develop more group home settings for children who are unable to live in traditional family settings.

• Define minimal standards of care -- "Rights of all children from birth".

• Foster parents must have authorization to provide health care for their foster child.

• Change the laws to put the responsibility on the biological parents who have lost the rights to their children.

• Burden is on the social worker to recommend medical care; foster parents cannot legally do so.

• Minimal and irregular contact with the social worker:

• Incidences of only one report in 3 years;

• Is there a lack of contact because caseloads are too high?

• Lack of training for social workers and particularly for aides who are the most likely to see the child.

• Assign medical social workers to address only medical needs.

• · Children don't receive services when in emergency placement.

• It is becoming increasingly more difficult to find services through QUEST.

• It is particularly difficult to find psychological services.

• Limitation on the QUEST budget -- who's not going to receive care?

• Put more money in the system for aides and assistants to provide support to social workers.

• Establish a separate medical coverage program just for foster children. Provide foster parents with a list of available providers.

• Focus the service plan on the child's needs rather than the parents.

• Evaluate with outcome studies the programs provided in service plans. Do these programs work?

• Give special consideration for children in CPS care under QUEST. They should all be categorized "special needs".

• More prevention programs.

• The report with recommendations from a mandated, multidisciplinary team can be "buried" by the social worker.

• Mandate that the multidisciplinary team's report be filed directly with the judge.

• Mandate that all reports go the judge, independent of the social worker's discretion.

• Require foster care review teams to evaluate cases and its outcomes.

• Constitutional problems exist relating to rushing cases through the court.

• Address the issue of non-compliance on the part of the biological parents. Is minimal compliance enough?

• Social workers need guidance from the legislature as to their role in court cases.

• Make the system more "child friendly" so children can be heard.

POLICY/DECISION-MAKING

• The process of removing children damages them further.

• Improve the process of removal and get the community involved.

• Remove the abusive/neglectful adult instead of the child.

• A Child Placement Response Team should determine if removal is warranted.

• Cap the number of children in the system.

• Hold parents accountable.

• Establish a formal process of implementation for CPS reform.

• Create a universal definition of "parental competency". It will be a standard guideline used by the multidisciplinary teams.

• Establish a clear policy on substance abusing parents and their ability to have the child in custody.

• Establish CPS caseload limits.

• Need more CPS workers.

• Is there a mechanism of relief for parents who are wrongfully accused?

• Rid the system of duplicative services - one child agency oversees.

• Establish a coordinator for child abuse services among DOE, DHS, DOH, and medical/mental health community agencies.

• Create a policy for caregivers that are substance abusers.

• Make sure services are available in areas that catch the unmonitored.

• Children need to be listened to.

• Foster parents need to be heard. They have an important role in documenting potential harm and follow through. Foster parent involvement will help develop a history of the family (i.e. identify drug abuse).

• People who know children best should be able to work with CPS, on behalf of the children, to make their transition the best.

• Clearance is needed to allow non-family members to assist families.

• Intake and the reunification process should involve the doctors, community, foster parents, and churches.

• Community must be involved in child abuse and neglect prevention.

• Develop and implement a systematic, standardized, multi-disciplinary team approach to determine risk/safety of the child.

• More agency and community collaboration in prevention programs.

• More multidisciplinary team involvement.

• Have community groups review systemic problems and identify resources needed to address community issues and problems (i.e. Title IV-B and Neighborhood Places).

• Those people who want to be involved need to petition Family Court to be a "party" to the case.

• Mandate that reports from foster parents, CPS workers, schools, doctors, children, and Guardian Ad Litem (GAL) be given directly to the judge.

• Review the Family Court System.

• Hold parents in contempt for "no shows".

• Release child information to the appropriate agencies, i.e. police and other agencies already working with the family. Get rid of confidentiality rule 17-920-1-8(c).

• If the abuser is known, prosecute criminally (§709-906, Hawaii Revised Statutes (HRS), Endangering the Welfare of an Incompetent Person; §709-904, HRS, Endangering the Welfare of a Minor in the Second Degree).

Child's safety first (physical and mental well being), reunification of family second.

• Cross-train all parties in the child's life to provide a smooth transition.

• School of Social Work to provide specialized CPS training in their program.

• Hold community roundtables on child abuse prevention.

• Media involvement to get the message out.

• Encourage community volunteer groups to work with families involved with CPS.

• When is their intervention in cases of abuse?

• Create a mechanism for parents who are wrongfully accused to report the accusations to a professional.

• Implement an external quality review process to review decisions, contractors, and provider services.

• Implement an external review process to automatically review cases that meet threshold criteria of abuse (matrix).

• Create an external review process for parents who feel they're wrongfully accused.

PROFESSIONAL AND PROGRAM RESOURCES

• Problems with reclassifying social workers: shortage differential.

• No standards for social workers.

• Reclassify/redefine minimum qualifications of CPS social worker positions to BSW or MSW.

• Not enough value (money, programs) placed in social services.

• Lack of substance abuse treatment services.

• There needs to be more community support so social workers can make referrals within the community.

• POS for more anger management programs.

• Structured shelter programs.

• Use physicians as resources in decision-making.

• Increase substance abuse treatment programs.

• Stronger programs.

• Increase eligibility that currently doesn't exist under QUEST.

• Allow Title IV-E monies to return to CPS rather than to the general fund.

• Must adequately compensate social workers. Compensation must be competitive to attract the best into the profession.

• Too legalistic to go through the court system (Chapter 587, HRS).

• Judiciary limits GAL compensation to 12 hours.

• Judiciary wants GALs to be volunteers and not necessarily attorneys. Children sometimes need representation by an attorney for legal matters.

• Appointment of GAL Administrator by Chief Justice for training and compensation.

• Judiciary needs to make GALs responsible for their work.

• Burnout is high among CPS social workers.

• GALs need ongoing training.

• More supportive and on-the-job training.

• Pursue Federal monies for training (Title IV-E monies).

• More practicum opportunities for MSW students in CPS system.

• Implement standards of assessment and competency.

• Give social workers the training, support, and tools to reduce burnout.

REPORTING/INVESTIGATIONS-DATA

• Streamline procedures for placement.

• Fill CPS vacancies to meet CWS standards.

• Increase resources for treatment and placement options.

• Assure user-friendly services.

• Mobilize resources in neighborhoods.

• Keep reports and data on all CPS deaths.

• Purge reports after 90 days.

• Implement risk matrix.

• Increased training for judges and attorneys.

• Educate the community on how to report CPS cases and how to be heard (i.e. videotape ('87) and on-going training).

• Conduct child death reviews.

• Differential reporting/investigation based on severity.

• For severe cases, initiate a specialized team, which includes forensic nursing, attorneys, police, etc.

• Standardization of investigation for all counties.

• Track families for repeated events.

• Implement a Team Management approach on Oahu for severe cases.