Policy
PCSAs are required to recommend placement settings that are in the best interest of children, “least restrictive”, and most “family-like”. To ensure family continuity and placement stability, PCSA’s initially explore maternal and paternal relatives to assess their willingness and ability to assume temporary custody or guardianship. Additionally, priority consideration must be given to placing siblings together, unless it is not in the children’s best interest (OAC 5101:2-42-05).
Unless an emergency placement is needed, PCSAs must provide pre-placement services to the child, parent, and/or guardian when substitute care placements occur. Pre-placement services include counseling with the family to explore feelings about separation. PCSAs must provide at least one pre-placement visit with the caregiver prior to a child’s pre-placement. Expected communication patterns between the PCSA, child, family, and caregivers are discussed at this time to ease the placement transition and help the child adjust to the substitute caregiver. All of these actions have as there primary goal to provide continuity and stability during placement (OAC 5101:2-42-64).
Agency visits encourage placement stability and are designed to assess a child’s placement adjustment and continued need for out of home care placement. As previously mentioned, the caseworker visitation rule was revised to emphasize regular assessment of the child’s safety and well-being, as well as, the caregiver’s willingness and continued ability to provide care for the child. Visits are required no less than monthly regardless of placement setting (OAC 5101:2-42-65). When there is evidence that a placement may disrupt, PCSAs must make efforts to maintain the placement, including the provision of supportive services to the child and caregiver (OAC 5101:2-42-88).
Practice
Based upon 2002 AFCARS baseline data, Ohio’s CFSR PIP goal for increasing foster care stability was 86.4% from 84.5%. According to Ohio’s CFSR Eighth Quarterly Report, Ohio achieved this Goal. Ohio successfully achieved all PIP Action Steps including:
• Assisting counties in determining the most appropriate placement for the child, providing support to maintain the child in that placement until the child can return home or be placed in another permanent setting. Ohio developed a best practice resource manual and disseminated it to PCSAs. Ohio also coordinated a panel of presenters for workshops at the PCSAO’s annual Child Welfare Conference and at ODJFS’ Annual Foster and Adoption Conference to showcase best practices.
• Holding annual conferences and sponsoring resource family attendance at conferences to improve understanding of the needs of foster youth. On June 22-24, 2006, a conference of more than 300 resource families was held in collaboration with the Ohio Family Care Association (OFCA).
Workshops helped families better understand and respond to the needs of foster youth, achieve permanency by educating caregivers about reunification, adoption, guardianship, and relative placements, and improve retention of resource homes by building caregiver coping skills. OFCA hosted another resource family conference on June 14-16, 2007 entitled ‘Taking Care of Yourself in the Wild, Wild West’. Workshops for foster, adoptive, kinship and respite parents as well as agency caseworkers/professionals were presented. OFCA continues to provide resource family support and training to strengthen placement stability.
• Sponsoring resource family attendance at annual conferences to help them gain information on meeting a foster child’s needs.
• Providing county specific, focused technical assistance to PCSAs with the highest percentage of children who have been in foster care less than 12 months who have experienced more than 2 placement moves; and that had the greatest adverse impact on overall statewide performance.
• Assisting counties with resource family recruiting efforts.
During CPOE Stage 6 Reviews, PCSAs not meeting the Placement Stability National Standard developed some of the following QIP strategies:
• Reviewing after hours and crisis matching processes for children coming into care;
• Improving “matching form” documentation and updating information more frequently;
• Reviewing internal protocols and policies for placing youth with relative/kin;
• Implementing Level of Care Tools to evaluate placement needs/appropriateness;
• Requiring Family Team Meetings/staffings prior to placement moves;
• Requiring caseworkers to involve other professionals (such as therapist’s recommendations) prior to moving youth into more restrictive settings;
• Conducting quarterly reviews of disruption data to analyze trends;
• Increasing collaboration between the PCSA, courts, and hospitals to coordinate treatment stays and discharge needs.
Changes in Performance and Practice
For the past four years, Cuyahoga and Hamilton counties have utilized level of care instruments to assist PCSA staff in determining the most appropriate type of out of home care placement based upon a child’s strengths/needs and a provider’s capacity/treatment components. Both counties have added staff support resources to assist caseworkers and service providers in making placement decisions and monitoring service delivery.
As reported in the CFSR PIP and the prior section, Ohio is committed to working with PCSAs to recruit resource families to meet the needs of children. Training and support enable foster and adoptive families to better provide appropriate services to children, particularly those with serious emotional/behavioral problems. Training and educational opportunities are provided to foster families to encourage foster family retention and enhance caregiver skill sets to reduce the likelihood of placement disruptions.
Resource family recruitment and retention strategies include:
• Analyzing FFY 2002 AFCARS data submissions of PCSAs with significant populations of out of home care youth;
• Collecting, compiling and sharing information from other states on resource family recruitment/retention best practices;
• Providing presentations at annual workshops including the Public Children Services Association of Ohio’s Annual Child Welfare Conference and the ODJFS’ Annual Foster and Adoption Conference;
• Integrating resource family recruitment/retention efforts by partnering with “Adopt US Kids” to promote permanency by increasing the availability of resource families;
• Providing and promoting public awareness materials to local agencies to supplement Foster Care Recruitment Month in May.
Casework Practices and Resource Issues
CPOE 6 reviews, as well as CFSR PCSA workgroup discussions, reveal differences in how PCSAs report and electronically record placement moves. Some counties report temporary moves (such as detention stays, hospitalizations, respite stays) as placement moves. A few PCSAs report financial incentives (the ability to claim Title IV-E) also encourages the county to record “placements” whenever possible to ensure adequate funding availability.
Delinquent youth who are placed is PCSA custody are seen as very challenging and few resource families are available to meet the needs of this population. As a result, disruptions occur at a higher rate.
Evaluation
Ohio consistently performs well in ensuring stable out of home placement environments for children. For analysis purposes, stability is defined as two or fewer placement settings for children who are in care less than 12-months. From FFY 2000 through FFY 2006, FACSIS data indicate the rate of children with stable placements ranged from 86.0 percent to 87 percent. This can be attributed to CFSR PIP activities and CPOE Quality Improvement Plan activities. The following table presents the overall stability levels.
Ohio
Children Checked for Stability Children with Stable Placements Percentage of Children with Stable Placements
Although, Ohio’s overall placement stability indicator performance is good, major metro county performance has declined each year from FFY 2000 (86.9 percent) through FFY 2006 (82.8 percent). As these counties were responsible for 42.5 percent (74,472 of 175,311) of all Ohio children checked for stability in the past seven years, reversing this downward trend is critical for Ohio, as a whole, to maintain and improve upon this performance indicator.
.
Ohio
Percentage of Children with Stable Placements by County Size FFY 2000 - FFY 2006
Major Metro Metro Large Medium Medium Small Small
50.0%
Children Checked for Stability Children with Stable Placements Percentage of Children with Stable Placements
Ohio
Percentage of Children with Stable Placements by County Size FFY 2000 - FFY 2006
86.9% 86.3% 87.2% 90.5% 88.9% 89.0%86.4% 86.8% 87.1% 87.3% 90.4% 88.5%
85.1% 85.2% 87.8% 86.8% 89.8%
84.9% 86.8% 88.4% 89.6% 89.5% 89.3%
84.0% 87.7% 90.1% 88.4% 90.9% 90.6%
83.6% 87.6% 89.4% 89.5% 91.9% 90.9%
82.8% 88.0% 90.3% 89.3% 91.3% 91.6%88.9%
50.0%
Major Metro Metro Large Medium Medium Small Small
FFY 2000 FFY 2001 FFY 2002 FFY 2003 FFY 2004 FFY 2005 FFY 2006
From FFY 2000 through FFY 2006, young children were far more likely to have stable placements than teenagers.
Ohio
Percentage of Children with Stable Placements by Age FFY 2000 - FFY 2006
13,001 11,878 29,014 21,983 20,077 20,656 23,146
35,451
Children Checked for Stability Children with Stable Placements Percentage of Children with Stable Placements
Ohio
Percentage of Children with Stable Placements by Age FFY 2000 - FFY 2006 FFY2000 FFY2001 FFY2002 FFY2003 FFY2004 FFY2005 FFY2006
The May 8, 2008 Ohio Child and Family Services Review Data Profile indicates PIP interventions, CPOE Stage 6 QIP strategies, and continued local efforts are resulting in a steady decline in the number of placement moves. The FFY 2007ab State Score was reported at 100.9. Children in care for less than 12
months who had two or fewer placements continued to increase as evidenced in the Table below. Since 2004 Ohio exceeded the 75th Percentile.
For children in care between 12-24 months there was a steady increase in reducing the number of placement moves. Between 2004 to the present, Ohio exceeded the national median of 58.9 percent.
From the period under review through FFY 2007ab Ohio has exceeded the established 75th Percentile set at 65.4%.
Children in care for 24 months or more appears to be one of Ohio’s most difficult performance challenges.
However, with PIP intervention strategies, the 12-month period ending March 31, 2007 data reflect a continued increase in placement stability. At that time, Ohio started to exceed the national median of 33.9%. settings for children in care for less than 12 months. Of all children served in foster care (FC) during the 12 month target period that were in FC for at least 8 days but less than 12 months, what percent had two or fewer placement settings? [national median = 83.3%, 75th Percentile = 86.0%]
86.2% 86.1% 86.3% 86.8% 87.3%
Measure C4 - 2) Two or fewer placement settings for children in care for 12 to 24 months. Of all children served in foster care (FC) during the 12 month target period that were in FC for at least 12 months but less than 24 months, what percent had two or fewer placement settings? [national median = 59.9%, 75th Percentile = 65.4%]
61.5% 62.5% 64.4% 66.1% 67.2%
Measure C4 - 3) Two or fewer placement settings for children in care for 24+ months.
Of all children served in foster care (FC) during the 12 month target period that were in FC for at least 24 months, what percent had two or fewer placement settings? [national median = 33.9%, 75th Percentile = 41.8%]
31.4% 31.3% 33.6% 34.7% 35.9%
Factors Affecting Performance on Permanency and Profile Element XII [Permanency Composite 4, including measures (1), (2), and (3)] and First-time Entry Cohort Data Profile Element IV The following strategies effectively helped Ohio increase Placement Stability:
• Providing Focused Technical Assistance and Process Consultation to two major metro counties;
• Improving initial placement matching procedures;
• Collaborating with courts to reduce placement moves;
• Analyzing “disruption” cases to better understand trends and service needs;
• Increasing visitation with foster caregivers and children to provide additional support;
• Implementing Family Team Meetings and “placement/disruption” conferences involving families, substitute caregivers, service providers and caseworkers.