CFRP Follow-Up Report 1999

CHILD FATALITY REVIEW PANEL 

THE CHILD ADVOCATE’S FOLLOW-UP REPORTS
TO THE CHILD FATALITY REVIEW PANEL’S INVESTIGATIONS
INTO THE DEATHS OF
ANDREW M., SHANICE M., RYAN K., AND TABATHA B.

April 16, 1999

Introduction

Investigation into the Death of Andrew M. - Parts I and II

Recommendations made to the Department of Public Health

Recommendations made to the Department of Children and Families

Recommendations made to the Judicial Branch

Recommendations made to the Office of the Attorney General

Recommendations made to the Department of Education

Investigation into the Death of Shanice M.

Recommendations made to the Department of Public Health

Recommendations made to the Department of Children and Families

Additional Feedback to Panel Recommendations

Investigation into the Death of Ryan K.

Recommendations made to the Department of Children and Families

Recommendations made to other entities

Investigation into the Death of Tabatha B.

Recommendations made to the Department of Children and Families

INTRODUCTION

Pursuant to Connecticut General §§46a-13l(b) and (c), the State Child Fatality Review Panel is mandated to review the circumstances of the death of any child who has received services from a state department or agency addressing child welfare, social or human services or juvenile justice.

During 1998, the Panel conducted four in-depth reviews in the cases of Andrew M., Shanice M., Ryan K., and Tabatha B. On October 14, 1998, the Panel agreed that follow-up of Panel recommendations was critical to the welfare of the children of this state and would be conducted by the Child Advocate no sooner than four months from the date of the issuance of each report.

The following is a detailed summary of follow-up agency responses and findings to recommendations made by the Panel in each of the four child fatalities reviewed.

FOLLOW-UP REPORT OF THE CHILD ADVOCATE

INVESTIGATION INTO THE DEATH OF ANDREW M. - PARTS I AND II

On March 22, 1998, eleven year old Andrew M., a child committed to the Department of Children and Families, died as a result of being physically restrained in a psychiatric hospital. Pursuant to Connecticut General Statutes sections 46a-13l (b) and (c), the State Child Fatality Review Panel investigated Andrew’s death and issued two public reports on May 7, 1998 and June 19, 1998. In these reports, the Panel addressed both the circumstances surrounding Andrew’s death as well as the child welfare case management provided to him during his lifetime and rendered recommendations to the state agencies involved where appropriate. Recently, the Child Advocate contacted the Department of Children and Families, the Department of Public Health, the Department of Social Services, the Department of Education, the Judicial Department and the Office of the Attorney General to ascertain what agency actions, if any, have been taken in response to these recommendations. The Child Advocate has concluded the following with regard to specific recommendations:

A. Recommendations Made to the Department of Public Health (DPH)

Recommendation #1: DPH should formulate regulations that address the development of behavior management and appropriate physical restraint policies for use in the facilities that they license and for ensuring that staff is properly trained (and retrained on a yearly basis). (Suggested guidelines were contained in the report as well). DPH should also promulgate a statewide uniform policy of behavior management and physical restraint for all facilities it licenses.

Agency response: DPH does not feel that promulgating regulations is the appropriate approach to the resolution of this issue. The agency plan is to work more closely with DCF and to enhance its own oversight. The plan is to follow up DCF investigations involving specific children and complaints and broaden DPH’s investigation to include all similarly-situated populations. DPH intends to apply "outcome-based standards" as opposed to specific regulatory guidance in policing the institutions under its jurisdiction.

DPH regulates a variety of health care settings which provide care and services to frail, vulnerable health care recipients of all ages. They support the establishment of standards for the utilization of restraints in health care facilities regardless of age of the resident. As opposed to regulation, DPH supports the establishment of those standards by statute, which would require the various types of health care facilities licensed by DPH to develop and implement safe and appropriate behavioral management and physical restraint policies.

To date, DPH has participated on the Best Practices Restraint Panel convened by DCF and also participated in the development of interpretive guidelines for the draft regulations developed by the panel. In addition, DPH has developed and implemented a plan to review DCF client placements in Psychiatric Hospital/Units.

The Child Advocate has proposed legislation to mandate that DPH promulgate regulations regarding the use of physical restraint in the facilities it licenses.

Recommendation #2: DPH should promulgate regulations designed to ensure that all psychiatric hospitals observe the civil rights of children admitted to their program.

Agency Response: It is DPH’s position that State and federal civil rights protections already exist for all people, including children, who are admitted to psychiatric hospitals. State statute requires a list of all in-hospital rights to be prominently posted in each ward where mental health services are provided. This list is required to include, but is not limited to, a) the right to leave; b) the right to a hearing; and c) the right to file a complaint. During the inspection process department inspectors verify hospital compliance with such posting requirements.

The Child Advocate believes that a notice requirement that is age level appropriate should be considered in response to this recommendation.

Recommendation #3: Every psychiatric hospital, psychiatric unit of a general hospital, and residential facility for psychiatric patients should promulgate a policy delineating a standard for use of physical restraints in patients with medical conditions or on medication which may affect their response to physical restraint.

Agency response: Same as Response to Recommendation #1. The care and services provided to psychiatric patients in licensed health care facilities is driven by the assessment of the individual’s needs, and the development of an individual health care plan to address those identified needs. Said plans include, at a minimum, psychiatric and medical diagnoses, and medication and treatment regimes. The client’s individual health care plan is the appropriate mechanism for delineating any contradictions concerning the use of physical restraints for that particular health care recipient. Department inspectors randomly review health care plans to ensure patients are receiving appropriate care and services.

The Child Advocate believes that restraint holds that obstruct an airway should be banned by DPH regardless of the individual’s health care plan.

Recommendation #4: DPH should promulgate a statewide uniform policy of behavior management and physical restraint for all facilities that it licenses.

Agency response: As stated in recommendation #1, the Department favors a statutory approach which establishes a uniform approach to regulating behavioral management and physical restraint policies throughout the health care industry.

The Department of Public Health and the Department of Children and Families continue to work in a collaborative manner, on an on-going basis.

B. Recommendations made to the Department of Children
and Families (DCF)

Recommendation #1: DCF should formulate regulations that address the development of appropriate physical restraint policies for use in the facilities they license, and for ensuring that staff is properly trained (and retrained on a yearly basis). (Suggested guidelines are contained in the report as well). DCF should thoroughly evaluate the behavior management policies and practices at every facility in which children for whom it is responsible receive treatment.

Agency response: DCF, in conjunction with its Best Practices Restraint Panel and a working group comprised of representatives of treatment facilities and other entities, has drafted regulations regarding the use of physical restraint which address virtually all of the specific recommendations made by the Child Fatality Review Panel as well as the Best Practices Panel’s recommendations. While the regulatory process is pending, DCF has issued the regulations in the form of directives to the facility it licenses, making the implementation of its policy a condition of licensure, and conditioning the placement of DCF children in facilities not licensed by DCF on compliance with its directives. Additionally, DCF has increased its efforts to educate facility staff about behavior management issues. DCF has also partnered with the Connecticut Association of Non-Profits to implement across-the-board institutional change and to develop a method of assessing the degree to which this change has been internalized by individual staff.

Recommendation #2: DCF should establish procedures for safety for those facilities, such as many shelters, that do not utilize physical restraints. For example, prior to admission, each child should be assessed for severity of behavioral problems, and the information should be provided in written form to the facility. Additionally, DCF should have a plan for the immediate removal of a violent child from a facility that is unable to safely manage her or him.

Agency Response: With respect to shelters and other facilities that do not employ physical restraints at all, DCF is working with those entities to ensure the safety of the children entrusted to their care. The shelters are encouraged to take advantage of an administrative process if they feel a particular child cannot safely remain in their facility. DCF is also developing subacute units in more structured settings such as residential placements to alleviate the need to place the more difficult children in shelter settings. The Commissioner has recently announced a "safe home" initiative which envisions the creation of short-term, congregate care environments designed to assess the needs of the child immediately upon being taken into care and to determine the most appropriate long-term out-of-home placement.

The Child Advocate continues, however, to be concerned about DCF’s "no reject-no eject" policy that requires shelters (most of which do not have staff trained to handle severely out-of-control children) to accept and maintain all DCF placements without regard to the child’s behavioral history. This policy places not only the child but other children in the facility at-risk as well.

Recommendation #3: Individuals should be trained in Cardio-Pulmonary Resuscitation (CPR-basic life support) in residential facilities and psychiatric hospitals.

Agency Response: DCF now requires that all direct care providers in all facilities utilized by DCF be trained in cardiopulmonary resuscitation, and offered to pay for such training through the end of 1998 to bring all facility staff up-to-date. DCF and the Connecticut Association of Non-Profits are collaborating to ensure that all facilities err in the direction of increased training by developing a "Train the Trainers" program.

Recommendation #4: DCF should incorporate in its training information concerning the civil rights of children in psychiatric hospitals to ensure that social workers are aware of, and do not deny children, these rights. Additionally, DCF should notify the attorney for the child immediately upon any inpatient psychiatric hospitalization.

Agency Response: DCF continues to stress to its workers that attorneys for children be notified immediately upon a change of placement to ensure that their civil rights are observed. DCF fully supports the concept of full and open disclosure of information to a child’s attorney and/or guardian ad litem.

Recommendation #5: DCF, in conjunction with the provider network, should develop an ongoing professional forum for the treatment of children with mental health needs, with the long range goal toward the development of treatment approaches to reduce the need for physical restraints.

Agency Response: DCF is developing and coordinating a training forum with several psychiatric facilities to address common concerns and develop methods for improving services. Additionally, DCF has established a Best Practices Panel charged with formulating regulations concerning the use of physical behavioral interventions, as well as interpretive guidelines for the regulations, prepared by DCF in conjunction with the Connecticut Association of Non-Profit Organizations, representatives from private service provides, family advocates, and the Office of the Child Advocate. Finally, new DCF regulations call for the appointment of a standing panel comprised of both public and private sector representatives who will:

• review all curricula used to train staff in the application of physical behavioral intervention (PBI);
• review requests for the use of alternative PBI curricula or techniques;
• assist in the collection and distribution of statewide data related to restraint;
• provide an ongoing forum for review and evaluation of the PBI regulations and interpretive guidelines;
• provide a centralized forum for the collection and analysis of interagency data, regulations and interpretative guidelines regarding PBI; and
• provide recommendations to DCF regarding modifications to the regulations and interpretive guidelines.

Recommendation #6: DCF needs to continue its movement towards effective policy and practice that reflects the ongoing assessment and recognition of risks posed to children by all adults in the household.

Agency Response: DCF maintains that it has been in the process of developing an ongoing assessment process for some period of time. Since the death of Ryan K., this development appears to have been accelerated, and, according to DCF, will be instituted statewide by April 1999. Staff training regarding the new assessment tools has already begun.

Recommendation #7: A competent, cumulative and timely narrative needs to be maintained and updated using a standard format that highlights physical danger as well as the number and substance of reports received on a given case.

Agency response: DCF indicates that this is an issue that continues to be stressed to social workers and supervisory staff. Random spot checks are being conducted on a more regular basis and the new assessment process includes components designed to identify problems with the narratives. A case worker’s failure to document according to established policy can and has resulted in disciplinary action against the individual.

The Child Advocate has found in a recent random review over the past few weeks of case narratives on the DCF LINK system that the documentation has significantly improved. The timeliness and thoroughness of narrative entries is much better while the quality of the narratives depends on the individual workers.

Recommendation #8: Any case with more than three neglect or abuse referrals, substantiated or unsubstantiated, in a twelve month interval, should be reviewed by a multidisciplinary team.

Agency response: Identifying patterns in "unsubstantiated" referrals poses a challenge because unsubstantiated referrals, by definition, theoretically do not involve risk to a child. According to DCF, the importance of reviewing and assessing all old referrals when new information is received is being stressed to the supervisors and front line social workers. DCF has instituted new policy by which multiple referrals are globally assessed by a management team. The new assessment process will reflect this global approach as well.

Recommendation #9: Cases in which there are chronic issues of neglect which have not responded to voluntary and timely cooperation should be brought before the court through the filing of neglect petitions

Agency Response: DCF is currently stressing the need to file neglect/uncared for petitions in cases involving uncooperative parents. DCF has also recently hired in-house attorneys to advise case workers and augment the services of the Attorney General. Additionally, the Commissioner has directed her staff to file neglect/uncared for petitions in Juvenile Court in those cases where appropriate.

Recommendation #10: The expert opinions of community professionals, such as physicians, must be afforded great weight in at-risk assessments of children

Agency response: DCF often solicits expert opinions when assessing children and gives those opinions serious consideration. However, the agency is often faced with conflicting medical opinions. Case workers are being encouraged to discuss conflicting professional opinions with supervisors, and to utilize the expertise of the Regional Resource Group staff.

Recommendation #11: DCF should take immediate and proactive steps on reports of chronic truancy.

Agency response: DCF is attempting to establish better working relationships with schools, which will hopefully result in a better informational flow. At the same time, it is important to note that schools must be mindful of their duties to perform outreach in conjunction with DCF’s responsibilities to respond, when a referral of truancy or educational neglect is made.

The Office of the Child Advocate continues to receive school official referrals on child absences with reports that DCF is unresponsive to truancy issues. This remains an area of concern to the Child Advocate, because when children are absent from school, they have lost their visibility to the community. In addition, a child’s failure to attend school is often a sign of other, more serious neglect or abuse issues present in the home. The Commissioner must continue to deliver the message to field case workers that educational neglect can be the basis for the filing of neglect petitions and that DCF should offer services in this area.

Recommendation #12: DCF needs to develop alternative creative placements for children to insure that their needs are being met in out-of-home care.

Agency Response : DCF has developed several initiatives that will result in additional services and quality placements for children including: a continuum of care RFP to begin in June 1999 which will provide in home community based services to children and their families with the goal of preventing the need for placement; the first of many safe homes will be established in the summer of 1999 to provide a safe, nurturing, stable environment where children coming into placement can be fully assessed; and a step down specialized foster care program is being established where residential facilities will develop specialized foster care beds to transition children back to their own communities.

Recommendation #13: In keeping with Connecticut’s legislative response to the federal Adoption and Safe Families Act, P.A. 98-272, DCF must act expeditiously in developing permanency plans for children in its care, particularly when there is little progress toward reunification demonstrated by the parent.

Agency Response: Since October 1, 1998, the effective date of this legislation, DCF has hired attorneys within its agency to assist in petition filing. There appears to be a dramatic shift in the agency’s approach to child protection cases and efforts made by DCF to reunify a family are more time limited. This process is being streamlined through DCF’s new assessment process. As a consequence, permanency for children is now expedited.

Recommendation #14: DCF must take primary responsibility for decision making on behalf of a child even in those cases where a private agency is providing services or placement to a DCF committed child.

Agency Response: According to DCF, the Commissioner is stressing DCF’s role as the primary authority over children in its care. Mandated reporter training has been updated and is being provided to a wider network of providers.

Recommendation #15: Foster parents must be provided with the complete educational, therapeutic, medical and child protection history of a child placed in their care in order for them to better meet the needs of the child and to protect other children in the home.

Agency response: According to DCF, this recommendation is being aggressively implemented by the foster care unit.

Recommendation #16: DCF must respond expeditiously to requests for removal of a child from a placement. The standards of the Child Welfare League and the recommendations of the American Academy of Pediatrics previously cited should be followed.

Agency response: DCF has concerns that requests for a difficult child’s removal come all too easily from the facilities which have contracted to provide placements to the more difficult children.

At the same time, the Child Advocate has met with a number of residential, group home and shelter providers and is very concerned that because of this policy of no eject-no reject, high-risk children are often inappropriately placed at facilities ill-equipped to address their needs solely because of the lack of an appropriate available placement. As a consequence, those children pose a risk to themselves and to other children and they do not have their physical or mental health needs appropriately met.

The Child Advocate believes that requests by foster parents for a child’s removal require DCF’s immediate response.

Recommendation #17: Medical Passport recommendations.

Agency Response: There appears to be a consensus that the current system for medical passports is not effective in providing much needed information to foster parents or DCF. DCF is exploring the electronic transmission of medical information as a substitute for the current medical passport system which is manually updated.

Recommendation #18: Children in DCF care should receive routine prophylactic dental care and treatment required.

Agency response: This appears to be a continuing problem for children in the system. According to DCF, there are insufficient numbers of managed care providers to meet the needs of all the children in care. It is a problem that must be addressed cooperatively by DSS and DCF and will be monitored by the Child Advocate.

Recommendation #19: Children’s attorneys should be notified by DCF when their client’s are hospitalized. DCF should, as a matter of policy, provide and periodically update the names, addresses, and telephone numbers of a child’s foster parents, therapists and schools to the child’s attorney.

Agency Response: DCF maintains that it consistently reinforces with its case workers the importance of keeping children’s attorneys informed.

Recommendation #20: DCF, in conjunction with the provider network, should develop an ongoing professional forum for the treatment of children with mental health needs, with the long range goal being the development of treatment approaches to reduce the need for the use of physical restraint.

Agency response: In addition to the Commissioner’s Best Practices Restraint Panel, DCF is also meeting with the Connecticut Association of Non-Profit Organizations, the Child Guidance Association and other agencies and providers to address this need.

C. Recommendations Made to the Judicial Branch

Recommendation #1: There were several recommendations made regarding the standards for children’s attorneys that should be imposed by the Judicial Branch. First, they should be required to personally meet with their clients as closely as possible to each court and status conference date. Second, they should not enter into agreements with other parties without first ascertaining the child’s position on the matter, except when the child is very young or preverbal. Third, children’s attorneys should be prepared to describe to the court the extent of their non-privileged involvement in the case since the last court date and to report on the child’s position. Fourth, the court should routinely inquire regarding the date counsel last met with their clients, what other action the attorney has undertaken on behalf of the child since the last court date and whether the agreement represents the child’s stated position on the issues.

Agency Response: In July of 1998, the Judicial Branch promulgated guidelines concerning appointment of attorneys and guardians ad litem for children and indigent parents in non-delinquency matters. The policy was adopted to direct:

• the appointment and training of attorneys and guardians ad litem for children and youth in all child protection and Families and Service Needs proceedings;
• the appointment of counsel for indigent parents and other adult legal parties in child protection proceedings; and
• the appointment of guardians ad litem for adults found to be incompetent by the court.

These guidelines were revised in December of 1998. Areas addressed in these revisions include: early termination of contracts and changes in the fee schedule, which were made in response to attorney complaints.

Recommendation #2: The Judicial Branch, in collaboration with OCA, should promulgate uniform standards for the representation of minor children in juvenile and family court cases, perhaps modeled on those developed by the American Bar Association and develop a system for verification of adherence to those standards

Agency response: As referenced above, the Judicial Branch has established written guidelines for representation. Those guidelines are, in fact, in accordance with the American Bar Association’s Standards of Practice - Juvenile Justice Standards (1979), and the ABA Standards of Practice for Lawyers Representing Children in Abuse and Neglect Cases (1996). Again, as mentioned above, the guidelines revised in December of 1998 outline the Judicial Branch’s policy with regard to early dismissal from contract services.

Recommendation #3: The Judicial Branch, in collaboration with OCA, should develop mandatory curricula for attorneys who wish to represent children. This should include a preliminary "basic" course, required of all attorneys prior to the assignment of the first case, and an annual "advanced" or "refresher" course.

Agency response: In order to be considered for a contract, attorneys now must participate in basic and advanced training to effectively represent children. In addition to this training, attorneys who are new to child representation are generally assigned to cases with a more experienced attorney who serves as a mentor.

The Judicial Branch has collaborated with the Office of the Child Advocate to provide training for attorneys – the most recent of which was held in November of 1998 on the role of the guardian ad litem and the implementation of the Adoption and Safe Families Act. Future training initiatives are anticipated to occur in conjunction with the Office of the Child Advocate.

Recommendation #4: The Judicial Branch, in collaboration with OCA, should develop a system to monitor the performance of attorneys for minor children, whose clients cannot usually obtain effective counsel on their own. This monitoring system should include assessment of attorneys performances including attendance in court.

Agency response: The Judicial Branch conducts an annual review of attorneys soliciting contracts and renewals to provide legal representation to children. The review includes: (1) whether the attorney is in good standing, (2) past experience representing children in juvenile matters, (3) past and continuing participation in educational programs, and (4) general attendance and preparedness for court proceedings. The Judicial Branch will continue to collaborate with the Office of the Child Advocate to provide training and technical assistance to attorneys representing children and guardians ad litem appointed by the Judicial Branch to represent children in proceedings before that court.

Recommendation #5: The Judicial Branch needs to assess the manner in which attorneys for children are compensated. The current system provides little incentive to attorneys to provide quality legal representation that may be time consuming.

Agency response: The Judicial Branch has suggested that the responsibility for the hiring and oversight of attorneys for children be moved to another entity, perhaps to a commission or to the Office of the Child Advocate. The Judicial Branch plans to release a request for proposal by the end of the year to solicit innovative approaches for legal representation for children and families. A pilot program will be conducted to expand on the current offerings of contracts to allow attorneys, firms, legal service organizations and other entities to develop models for representation and propose compensation levels. The pilot program will be conducted within available appropriations.

The Judicial Branch is committed to providing the best possible legal representation for children and is interested and willing to work with other entities to attain this goal. They agree that the rate of compensation for court appointed attorneys for children should continue to be re-examined; however; any changes in the level of compensation need to be included as part of the State Budget.

D. Recommendations to the Office of the Attorney General

Recommendation #1: The Office of the Attorney General should require all new AAGs assigned to the Child Protection Division to undergo basic training in child protection representation and litigation prior to being assigned to a juvenile court venue, with in-house continuing legal education requirements.

Agency response: The Attorney General has made significant efforts to improve training. He has instituted a number of child protection training sessions for all attorneys in that department. New attorneys are given an introductory program and assigned to work under senior attorneys who monitor their progress. Additionally, the litigation training program has been expanded to include regular training on specific litigation skills as well as an annual week-long intensive trial training course. The full text of Attorney General Blumenthal’s comments can be found in Appendix B.

Recommendation #2: The Office of the Attorney General should develop an internal practice manual that includes policies and procedure for the handling of the various types of legal issues that arise in the child protection arena. For example, it should be standard procedure for the Assistant Attorney General to present written expectations at the time of the OTC and certainly no later than the date of adjudication. If there is no agreement, the AAG should request a hearing on the issue at the earliest possible time.

Agency Response: Child protection attorneys have access to a practice manual developed by Assistant Attorney General Arthur Webster who is also available for individual consultation. Additionally, an internal case index, developed by the Child Advocate and the Office of the Attorney General, has been brought up to date and is available to all staff.

Recommendation #3: DCF has every reason to demand and expect the highest quality of legal representation. Therefore, representatives of the Child Protection Division of the Office of the Attorney General, in conjunction with DCF Regional Administrators, should periodically assess the quality of legal representation in each juvenile court venue and develop and implement procedures designed to address issues of concern.

Agency response: The Office is developing strong ties with DCF’s new legal department and is working on streamlining procedures, developing new forms and checklists, and improving collaborations between the two agencies.

E. Recommendations made to the Department of Education

Recommendation #1: Educators must be vigilant and consistent in making timely referrals of chronic truancy and educational neglect.

Agency response: The Connecticut State Department of Education has established a protocol whereby an annual notice will be sent to all school superintendents and principals on the need for timely truancy and educational neglect referrals. Leaders of all educational organizations also will receive this notice, thereby helping to inform teachers and support staff.

FOLLOW-UP REPORT OF THE CHILD ADVOCATE

INVESTIGATION INTO THE DEATH OF SHANICE M.

On March 8, 1998, four and one-half year old Shanice M. died after cardiac arrest during a severe asthma attack, despite emergency medical intervention, after cardiac arrest during a severe asthma attack. The Department of Children and Families (DCF) had maintained an open treatment case due to allegations from medical providers that Shanice’s family was not treating her severe asthma properly. DCF had closed its case less than one month prior to the child’s death. Pursuant to Connecticut General Statutes section 46a-131(b) and (c), the Child Fatality Review Panel investigated Shanice’s death and issued a public report on July 22, 1998. In this report, the Panel addressed the issue of severe asthma in the inner-city child in general, as well as the circumstances leading to Shanice’s death and issued recommendations to the state agencies involved. Recently, the Child Advocate has concluded the following with regard to specific recommendations.

A. Recommendations made to the Department of Public Health (DPH)

Recommendation #1: The State of Connecticut should recognize that asthma is a serious threat to the children of the state, particularly in poor urban communities. The Department of Public Health should act in conjunction with medical institutions within the state to improve asthma care for our inner-city children.

Agency response: DPH, in recognition of the serious public health problem that asthma presents, particularly to children, has undertaken several initiatives to address this issue. The agency has established a number of surveillances designed to collect data regarding asthma for later analysis. Additionally, DPH is active in local health department initiatives and has participated in the planning of educational programs.

B. Recommendations made to the Department of Children and Families

Recommendation #1: DCF should rapidly move to create working, multidisciplinary teams in those regions which do not yet have them, in compliance with Public Act 98-241. Such multidisciplinary teams should routinely review any cases with three or more substantiated neglect reports within a twelve-month interval, in which a child in the household is under six years of age.

Agency response: Because multidisciplinary teams (MITs) are first charged with reviewing sexual abuse and serious physical abuse cases, DCF has determined that they will develop other criteria for review as indicated by regional need.

Recommendation #2: The Regional Resource Groups should be strengthened to provide adequate numbers of qualified nurses to meet the consultation needs of DCF staff. RRG nurses should be routinely consulted and involved in a continuing fashion in all cases involving medical neglect and children with special health care needs. They should be involved in (though not responsible for) decisions affecting legal action, closure of the case, or assignment of a new worker. They should routinely receive updates on the status of all medically fragile children in the region. Social work practice policy should include guidelines for referral to the RRG.

Agency response: DCF is in the process of developing policy which will delineate and standardize the referral of cases to the RRG, particularly for the RRG/RN assessment. There is no indication that the number of RRG nurses has been increased.

Recommendation #3: All DCF investigative and treatment social workers should receive ongoing training regarding common, but serious, health care issues such as asthma. Such training should include a review of common childhood illnesses as well as illness management principles and effective communication and collaboration with community health providers. Additionally, consultation with the regional pediatric physician consultant should be routine in cases where there is conflict between treating physicians or between treating physicians and the family. Social workers and nurses should have ready access to general and specialist pediatricians for consultation on specific cases.

Agency response: In-service training regarding asthma has been developed and offered. Other medically related training is offered both in pre-service and in-service

Recommendation #4: Legal action (the filing of neglect petitions) is indicated when there is repeated noncompliance with service agreements, particularly when the parent has already been warned of this potential consequence. Social workers should request advice from the regional legal counsel or the Assistant Attorney General assigned to that Region if there are any questions regarding the criteria for legal action.

Agency response: According to DCF, their Regional Administrators and the AAGs have met to develop systems for consultation regarding legal action needed to gain compliance with families. The addition of staff attorneys in each region has increased the availability of legal consultation.

Recommendation #5: The expectations of service agreements should be shared with professionals whose services are required by the agreement. Those agencies or individuals should provide periodic, written documentation concerning the degree of compliance with the terms of the service agreement.

Agency response: a Treatment Plan Coordinator has been identified in each office to ensure community participation in the development of treatment plans. It is DCF’s position that the Administrative Case Review process provides for consistent semi-annual review of cases, including documentation of services by community service agencies.

Recommendation #6: DCF narrative entries into the LINK computer system should be made in a timely fashion, no more than three days after the events described, as required by DCF policy. Each region should establish the practice of conferencing all new investigations on cases already active in on-going services.

Agency response: Timely narrative entries are expected pursuant to DCF policy and dealt with through progressive discipline when not adhered to. The ACR process will hopefully identify problems with timely narrative entry.

Recommendation #7: Difficult or complex cases, including cases of medical neglect and children with complex health problems , should not be given to social work trainees. Trainee case loads should be limited to permit individual attention during the training period.

Agency response: The protocol for the assignment of cases to trainees is currently being revised for the court monitor’s approval. Because a case worker’s "working test period" is ten months, cases of increasing complexity must be given to trainees to ensure that they understand the difficult nature of the work, to test their ability to competently handle a variety of cases and to give the training supervisor a gauge by which to measure the trainee’s ability to work in child protection. At the same time, Training Supervisors are responsible for closely supervising the trainee and his or her cases. It is hoped that this process will help to insure that no children "fall through the cracks."

Recommendation #8: In complex cases such as the case of Shanice M., visiting nurse agencies (or other involved mandated reporters) should be requested to provide DCF with documentation of their findings and assessments regarding a family’s willingness and ability to safely and effectively manage a child’s potentially life-threatening chronic illness. This is especially important when such an agency makes the decision to discharge a family from their service based on noncompliance or lack of availability on the part of a parent or caretaker. They also need to comply with child abuse and neglect reporting laws and refer suspicions of abuse and/or neglect to DCF.

Agency response: Agencies with whom DCF contracts are required to provide written reports on a regular basis. The Treatment Planning conference coordinator and Administrative Case Review will also address that need with those agencies, such as Visiting Nurse Associations, which provide services by other than a contractual basis.

Recommendation #9: DCF should include in its policy on case closure an expectation that cases involving mandated reporters will require written notification to the reporter when a decision is made to close the case.

Agency response: It is DCF policy to notify mandated reporters of the disposition of an investigation. In addition, It is expected that case workers will contact service providers before a case closure, to ensure that they are aware of the plan to close, to delineate the continuation of services and to acquire input from those agencies about the current functioning of the family and as assessment of the risk.

C. Additional feedback to Panel recommendations:

University of Connecticut School of Social Work Response: Dean Kay W. Davidson of the University of Connecticut School of Social Work has commented that the recommendations in this report are excellent and strongly supported by the School of Social Work. The School is prepared to become involved in collaborative planning for education and training and to develop a curricula relating to child welfare knowledge. The Child Advocate is currently meeting with Dean Davidson to assist in this endeavor. The full text of Dean Davidson’s comments may be found immediately following.

FOLLOW-UP REPORT OF THE CHILD ADVOCATE

INVESTIGATION INTO THE DEATH OF RYAN K.

On August 12, 1998, six-year old Ryan K., who was the subject of numerous referrals to DCF and had an open protective services case, died after a severe battering. His legal guardian was arrested and charged with his murder. Pursuant to Connecticut General Statutes sections 46a-13l (b) and (c), the state Child Fatality Review Panel investigated Ryan’s death and issued a report on September 17, 1998. In this report, the Panel addressed the circumstances surrounding Ryan’s death and the investigative procedures of the child protection agency, and issued recommendations to DCF. Recently, the Child Advocate contacted the Department of Children and Families to ascertain what agency actions, if any, have been taken in response to these recommendations. The Child Advocate has concluded the following with regard to specific recommendations:

A. Recommendations made to the Department of Children and Families

Recommendation #1: Social workers should be trained to be aware that generally positive factors such as the cleanliness of the home and the cooperation of the parents are sometimes superficial distractions that can mask serious problems within the family.

Agency response: Regional trainers have been assigned to each DCF region to provide hands on training including interviewing skills with the social worker (on a home visit) and organizational skills (at the work station of the staff member) as well. Additionally, the staff in the region handling the Ryan K. case have been re-trained on basic child protection issues and organization systems have been established that region to foster safety as the first priority in child protection.

Recommendation #2: DCF should file neglect petitions in Juvenile Court in those Probate Court cases that meet the legal standard.

Agency response: All open protective services cases in Ryan’s region, and all cases statewide which had been open over twelve months with no court involvement, were reviewed and corrective action taken.

Recommendation #3: DCF should open a protective services case in all Probate Court cases where neglect or abuse is alleged and the case is not transferred to Juvenile Court.

Agency response: DCF is currently revamping its policy regarding the agency’s probate court neglect and abuse cases and will address this recommendation.

Recommendation #4: DCF should establish uniform policy and clear procedures for social workers assigned Probate Court cases, and require comprehensive investigations of any relative seeking guardianship of a child.

Agency response: Policy regarding the use of Probate Court is being drafted, particularly concerning which cases are appropriate for a particular court, and how to develop the court studies. Additional policy is being drafted which will indicate that cases should either be court-involved or closed after twelve months.

Recommendation #5: DCF should notify Probate Court when referrals of neglect and abuse are received in those cases with prior Probate Court involvement.

Agency response: See Recommendation #3

Recommendation #6: Any report of suspected abuse of a child coupled with an observable injury should be investigated on the day that the report is received.

Agency response: A system has been established at Hotline for immediate assessment by a "regional response team" of school reports of abuse in order to determine the need for same day response. Policy is being revised accordingly. A meeting was held with superintendents and the Commissioner of DCF to establish a protocol for reporting abuse and for holding children at school. The protocol is being worked on by a subcommittee. Legislative change is being sought to ensure that schools provide access to children and not release children when a same-day investigation is deemed necessary by DCF.

Recommendation #7: DCF should develop an assessment tool that allows taking a fresh look at each new case or new referral within a family from a global perspective. This assessment must include carefully reviewing all past referrals, including those officially classified as "unsubstantiated," in order to identify problematic behavior patterns that may not be readily apparent in the snapshot of a single incident.

Agency response: Assessment training began in September 1998 and includes a comprehensive family and child assessment protocol. Various formats of this training are mandated for all social workers and social work supervisors. The training also contains a component on evaluating a case, including the impact of alcohol and substance abuse issues on the family. Changes in LINK to include Assessment and Treatment Planning are planned for July 1999. A training effort will be undertaken in this regard.

Recommendation #8: DCF should increase the allocation of Regional Resource Group staff to assist the social workers in assessing substance abuse, domestic violence and mental health issues.

Agency response: DCF is unable to increase numbers of staff but is increasing the utilization of the existing staff. The Regional Resource Group will be consulted regarding non-compliant substance-abusing parents.

Recommendation #9: DCF should assign members of the Special Reviews or Quality Assurance Units to conduct random reviews, in all regions, on a monthly basis, of open protective services cases that do not have court involvement, in order to determine the adequacy of case management. These reviews should include assessing record keeping and communication issues and should include a personal home visit by the reviewer.

Agency response: A plan has been developed within each region to conduct random monthly reviews of open cases.

Recommendation #10: The Child Advocate should conduct random independent reviews of DCF cases as she is made aware of cases that, in her determination, require such reviews.

Agency response: The Child Advocate reviews random DCF cases on a daily basis as those cases come to her attention through referrals from service providers, educators, and the public.

Recommendation #11: Children in potentially abusive or neglectful situations are at their most vulnerable when the school year ends because their visibility to the community may be nonexistent. Therefore, on all open protective services cases, DCF should increase its vigilance through increased home visits and contacts with community providers.

Agency response: In recognition of the increased risk to children who are not visible to their community, DCF has heightened their continued assessment and ongoing monitoring of children at risk.

Recommendation #12: By state statute, multidisciplinary teams must be established in every DCF region as of October 1, 1998. All open protective cases with multiple referrals of suspected abuse should be assessed by these teams.

Agency response: The multidisciplinary teams are geared toward coordinating cases of sexual abuse. There are not adequate resources available to address other cases.

Recommendation #13: DCF should make full use of the legal resources of the Office of the Attorney General in assessing whether a case legally constitutes abuse or neglect.

Agency response: The Assistant Attorneys General in each region will consult with staff on the appropriateness of court action to gain cooperation of a parent. Regional Administrators, investigations staff and all Program Supervisors have been directed to ensure that consult takes place.

Recommendation #14: Continuing education in child welfare issues should be mandated for every DCF social worker.

Agency response: Training has been revised to include a component on the integration of information from all sources in assessing child risk. Staff are mandated to attend in-service training each year.

Recommendation #15: Because the investigations unit makes life or death determinations regarding a child, those units of each region should be staffed by the most experienced and educated social workers and supervisors.

Agency response: Pursuant to the Consent Decree and as a matter of policy, DCF has staffed its investigative units with social workers with a minimum of two years of experience.

Recommendation #16: DCF should carefully assess the effectiveness and necessity of current paperwork requirements and make modifications accordingly. Additionally, DCF should explore alternate methods of documentation that free social workers to work in the field, such as increased use of clerical staff.

Agency response: A paperwork reduction committee has been convened and is in the process of reviewing all DCF paperwork responsibilities in an effort to reduce paper and process with a goal towards freeing the worker to provide direct case management services.

Recommendation #17: DCF should determine why policy regarding the entry of narratives on the LINK system is routinely ignored, and take corrective action immediately.

Agency response: Timely narrative entries are clearly expected and dealt with by progressive discipline when not adhered to. Training in documentation is mandatory in pre-service and offered as an in-service course.

Recommendation #18: Increased numbers of social workers should be hired to insure that Consent Decree caseload and supervisory requirements are met. The Consent Decree should be modified to allow for increased supervision of field social workers.

Agency response: Caseload distribution practices are being reviewed by the Regional Administrators and the Bureau Chief for Child Protection. Data system reports are being developed to ensure that Regional Administrators receive monthly reports which identify caseloads by office. Semi-annual reports of caseload distribution will be sent to the Commissioner. This issue has the oversight of the Federal Court Monitor as well.

Recommendation #19: DCF should standardize managerial and supervisory expectations and oversight throughout the regional offices. Uniform policy and guidance must come directly from the Commissioner's office.

Agency response: Social Work Supervisors must review all investigations to ensure compliance with policy and good case practice. Policy is being drafted to reflect this, supervisor training is being revised to incorporate this, and a plan is being developed to conduct semi-annual reviews of investigations in each region. .

Recommendation #20: DCF should require that diligent efforts be made to promptly inform all biological parents of substantiated reports of neglect or abuse involving their children.

Agency response: The Office of the Child Advocate has proposed legislation to this effect, which DCF has supported.

Recommendation #21: DCF should develop policy and procedures designed to encourage and increase the level of interaction and discussion between social workers and between regions so that, when families move, or when new reports are received, vital information is passed on.

Agency response: Policy is currently being revised to include the review of all prior DCF case records during an investigation.

Recommendation #22: DCF policy regarding case transfer conferences between the investigations and the treatment units should be strictly adhered to, and supervisors should be encouraged to hold such conferences whenever possible even if not specifically required by policy.

Agency response: A protocol is being developed to ensure that all transferred high-risk cases shall have a case transfer conference. It has been mandated that all Program Supervisors must read and review all transferred cases.

Recommendation #23: All community service providers in a given case should be invited to its treatment planning conferences. Social workers should request verbal or, preferably, written information from those providers who cannot attend.

Agency response: Staff have been allocated to coordinate and conduct Treatment Planning Conferences and to encourage the participation of community providers.

Recommendation #24: DCF should develop a closed records system that permits the immediate retrieval of past case records upon request. This must include the proper allocation of storage space at a central registry and sufficient staff to permit delivery of the record into the hands of the social worker within forty-eight hours of the request.

Agency response: In order to ensure that closed case records are acquired, a committee is reviewing how all offices maintain records and a Request for Proposal (RFP) is being developed to study and revise the system of closed records. Training in case record review is being studied for possible revision.

Recommendation #25: All DCF investigative and treatment unit staff should receive mandatory training in the recognition of child abuse, and in the behavioral indicators of an abused child.

Agency response: The Training Academy offers a multitude of in-service courses.

Recommendation #26: DCF must insist, in its contracts with outside agencies, that those agencies provide regular and timely progress reports on DCF clients. In addition, contracted social services providers must be required to immediately notify the social worker when significant events, such as a move, an arrest, a hospitalization, or case closure, occur.

Agency response: Written documentation of services and assessments are required of all agencies with whom DCF contracts. The Treatment Planning Conference and Administrative Review Process will provide a mechanism to ensure these reports are received. All providers are invited to attend the Conference and the Review.

Recommendation #27: Every state agency which regulates or contracts with entities employing mandated reporters should require training of those reporters in the recognition of child abuse and in state reporting requirements.

Agency response: DCF has implemented a train-the-trainer program regarding mandating reporting and has established a statewide standardized curricula.

Recommendation #28: Regional DCF offices should develop positive relationships with the school systems within their jurisdictions that will encourage increased cooperation and information-sharing when school officials suspect that a child is being neglected or abused. (Additionally, a system of training school personnel in the reporting of abuse has been established. Staff have been hired to conduct the training.)

Agency response: DCF will likely assign staff to specific geographic areas to foster better relationships between DCF and the communities.

Recommendation #29: DCF should undertake an awareness campaign to encourage medical providers to be alert for signs of neglect or abuse.

Agency response: Since July 1998, training has been provided to community agencies on at least 63 occasions, reaching over 1,600 mandated reporters.

Recommendation #30: In the major cities in Connecticut, DCF should house an investigative social worker in the police department in order to conduct more thorough multidisciplinary investigations.

Agency response: DCF is developing systems to ensure the establishment of relationships with police in each region’s jurisdiction. Each office is working to clarify and improve the joint investigations with police. Efforts are underway to co-locate DCF staff with police. This has already occurred in Hartford and New Haven.

Recommendation #31: DCF should allocate more resources for the prevention of child abuse. Additionally, DCF must actively work to integrate prevention efforts at the regional level, and involve all staff in community education initiatives.

Agency response: DCF allocates nearly $7,000,000 towards the prevention of child abuse efforts including alcohol and drug prevention, early childhood intervention, family supports, and parent education.

B. Recommendations made to other entities

Recommendation #1: The legislature should increase the resources of the Probate Court to permit formalizing the proceedings, i.e., to allow for the recording of all hearings and the mandatory appointment of an attorney or guardian ad litem for a child when a proceeding is initiated.

Agency response: The OCA has supported proposed legislation to mandate the recording of hearings and appointment of representatives for children.

Recommendation #2: Every telephone call or report to police alleging suspected child abuse should be logged and maintained as a record.

Agency response: The response of various police departments across the state is that the calls or reports are routinely taped, and maintained for various periods of time.

Recommendation #3: Every police response to such information should be followed up if access to the child is not gained at the time of the initial response.

Agency response: For the most part, follow-up does not occur if access to the child is not gained. However, a 136 abuse report is made by the police departments in many jurisdictions.

FOLLOW-UP REPORT OF THE CHILD ADVOCATE

INVESTIGATION INTO THE DEATH OF TABATHA B.

On September 28, 1998, fifteen-year old Tabatha B., a child dually committed to the Department of Children and Families (DCF) as a neglected child and as a delinquent child, died after a suicide attempt while she was incarcerated at Long Lane School. Pursuant to Connecticut General Statutes sections 46a-13l (b) and (c), the State Child Fatality Review Panel investigated Tabatha’s death and issued a two-part public report on November 30, 1998. In this report, the Panel addressed both the circumstances surrounding Tabatha’s death and the conditions at Long Lane School and issued recommendations to the Department of Children and Families (DCF). Recently, the Child Advocate contacted DCF to ascertain what agency actions, if any, have been taken in response to these recommendations. The Child Advocate has concluded the following with regard to specific recommendations:

A. Recommendations made to the Department of Children and Families

Recommendation #1: DCF should develop a hybrid program consisting of both correctional and treatment components in order to meet the varying needs of the diverse population of children served at Long Lane School.

Agency response: A comprehensive program review and evaluation that includes consultation from experts in the juvenile justice field and forensic psychiatry has been established to address juvenile justice, mental health and substance abuse issues at Long Lane School. DCF also plans to develop a balanced system of juvenile justice alternatives to support Long Lane residents for effective re-entry into community-based or residential services as well as appropriate policies, procedures and guidelines for all staff to effectively meet the needs of the juvenile justice population. Staff training, at a minimum, will include behavioral management, sexual abuse, substance abuse and suicide prevention, assessment and intervention.

Recommendation #2: DCF should immediately undertake efforts to meet as many ACA accreditation criteria as possible at Long Lane School. Any new facility and programs should be designed to meet all applicable ACA standards.

Agency response: Long Lane is in the process of developing a quality management system to achieve ACA accreditation. Accreditation will not actually be sought until the new facility is in operation. Legislation is currently pending to seek funding for a new facility, which proposal would meet ACA accreditation standards.

Recommendation #3: Long Lane School should be divided into separate components or units, with each component designed to meet the needs of a specific population of children placed at the facility. For example, there should be separate programs and treatment offered to children who have committed violent crimes, children who are status offenders, and children with long-term psychiatric needs.

Agency response: The Long Lane 21^st Century Advisory Committee, Steering Sub-Committee, has been established and is developing an alternative juvenile justice model and is designing a new state-of-the-art secure facility at Long Lane. Referred to in Recommendation #2.

Recommendation #4: Each child should be assessed upon arrival at Long Lane School to determine his or her physical, emotional and educational needs.

Agency response: DCF has established a 30-day diagnostic intake unit at the present Long Lane. Upon admission, a thorough assessment of the educational and treatment needs for each child is conducted and individualized treatment plans are prepared.

Recommendation #5: Caseloads at Long Lane in every department must be reduced commensurate with professionally established standards in order to provide appropriate treatment for and ensure the safety of children in the state’s care. Staffing levels must be increased to ensure:

• clinical caseloads that allow for proper documentation

• availability of appropriate clinical services to all children

• prompt and immediate assessments of all new admissions

• the development of treatment groups to include substance abuse treatment, social skills education, anger management, bereavement and loss, and sex offender treatment

• vocational education

• more timely psychological and psychiatric evaluations

Agency response: Short- and long-term staffing increases were approved and DCF personnel filled forty-eight new positions including clinical, educational, nursing, substance abuse and youth services staff. As of July 1, 1999, additional staff will be hired.

Recommendation #6: DCF should increase staffing to comport with the recommendations in the Loughran Report issued in March 1998.

Agency response: See previous response.

Recommendation #7: Given the nature of Long Lane’s changing population of increased numbers of children with serious psychiatric issues, Long Lane must have adequate clinical staff, such as psychiatric social workers or psychiatric nurses, on site at all times.

Agency response: Three psychiatrists from Riverview Hospital and two additional consultants have been utilized for on-call purposes. DCF has significantly improved its crisis response protocol, policy and procedures at Long Lane by refining the administrative and crisis on-call system and has increased the staff-to-resident ratio.

Recommendation #8: DCF must develop ongoing and intensive training for staff in such areas as adolescent development, suicide prevention, behavior management and crisis interventions.

Agency response: DCF at Long Lane has refined the suicide intervention policy to encompass expectations for timely response, appropriate follow-up and specialized training to address suicidal ideation, gestures, and attempts. Staff will receive clear, consistent direction in policy to assess crisis and develop procedures for contacting on-call staff. Clinical staff will respond by making face-to-face contact with the resident to assess their mental health condition.

Recommendation #9: DCF must increase training for clinical staff and require that all clinicians become licensed within a reasonable period of time.

Agency response: Increased training is now ongoing, focusing on suicide prevention, and behavioral intervention, including physical restraints. New hires are required to be LCSW licensed.

Recommendation #10: Clinical services must be made available to all children at Long Lane in a timely and consistent manner.

Agency response: Psychiatric intervention after any serious suicide attempt is now conducted by a psychiatrist at Long Lane. Middlesex Hospital is utilized when needed, and follow-up evaluation by a Long Lane psychiatrist occurs within twenty-four hours for any youth returned to Long Lane by Middlesex Hospital.

Recommendation #11: Targeted group clinical services, such as substance abuse, Alcoholics and Narcotics Anonymous programs, and anger management must be reinstituted and made available to all children at Long Lane.

Agency response: A comprehensive program review and evaluation that includes consultation from experts in the juvenile justice field has been established to address juvenile justice, mental health and substance abuse issues. The plan for the new facility includes these components necessary for therapeutic treatment.

Recommendation #12: DCF must develop a positive peer culture at Long Lane in accordance with the recommendations made in the Loughran Report.

Agency response: DCF has enhanced and established an integrative behavior management policy at Long Lane that includes provisions for clinical and administrative oversight. DCF at Long Lane will establish a Quality Management system to review the frequency and intensity of physical restraints, and profile residents most vulnerable to aggressive, self-destructive and suicidal behavior. An established committee is currently reviewing positive peer culture as well as other treatment milieu approaches and will make recommendation regarding the most appropriate approach for Long Lane.

Recommendation #13: A secure modern correctional/treatment facility must be built to meet the needs of children who are convicted of serious criminal offenses and who require a high level of security. The new facility should included a separate secure treatment unit established specifically to meet the treatment needs of those children who exhibit uncontrollable behavior such as truancy and running away or who are convicted of minor offenses.

DCF’s proposed facility, is currently pending before the legislation and satisfies this recommendation.

Agency response: The Long Lane 21^st Century Advisory Committee, Steering Sub-Committee, has been established to develop alternative juvenile justice models and design a new state-of-the-art secure facility at Long Lane to meet the needs of the diverse population.

Recommendation #14: Prior to the construction of a new facility, interim safety measures must be established in response to citations from the Fire Marshall’s office. Those violations that cannot be remedied entirely, require the development of alternative safety measures.

Agency response: Every cottage that is occupied has been renovated. One cottage, currently unoccupied, is currently having sprinkler systems installed. Fire hazards in all buildings have been corrected to the satisfaction of the State Fire Marshall.

Recommendation #15: DCF should establish an internal review unit designed specifically to investigate abuse or neglect allegations made against any DCF employee. Each investigation should include at least one non-DCF investigator.

Agency response: The Special Investigations Unit, located at the Hotline and staffed by DCF employees only, fulfills the role of investigating DCF facilities, DCF licensed facilities and DCF employees. This unit does not include the participation on non-DCF investigators.

Recommendation #16: Long Lane School police should have an internal review procedure of allegations of misconduct and use of force against children, along with policy that clearly establishes the continuum of permissible force and procedures for conducting the reviews.

Agency response: All use of restraints are reviewed by a multidisciplinary committee. Policy has been revised to address the use of restraints and review procedures.

Recommendation #17: The child protection agency should never permit its own employees to dictate the parameters of or obstruct an investigation of alleged child abuse. Employees who refuse to cooperate or deliberately fail to adequately document incidents should be held accountable.

Agency response: DCF agrees, and administration is currently developing a system with DCF Hotline, Labor Relations, DCF’s Personnel Division and Long Lane School administration to insure cooperative investigations. In addition, a multidisciplinary team reviews all restraints.

Recommendation #18: DCF should establish standards for the use of physical and mechanical restraint on the children at Long Lane School, using Judicial Branch standards for juvenile detention as a guide.

Agency response: A restraint review committee has been established at Long Lane to review all restraints. Additionally, a Quality Management system now reviews the frequency and intensity of physical restraints, and profiles residents most vulnerable to aggressive, self-destructive and suicidal behaviors. Recommendations are made to avoid restraint use.

Recommendation #19: Long Lane police officers and staff should receive intensive and ongoing training in the use of passive restraint.

Agency response: Staff training and supervision at Long Lane now reflects an emphasis on integrating and balancing juvenile justice and mental health. Training now includes the continuum of behavioral interventions and suicide prevention. The "Handle with Care" restraint training is currently being utilized.

Recommendation #20: DCF must ensure, through the hiring of sufficient staff, the provision of adequate computer resources, and the implementation of high standards, that documentation in all departments is completed in a professional, thorough and timely manner.

Agency response: At present, Long Lane is not "computerized". The plan is to develop a central record keeping system and to modify policy to emphasize the timely recording of daily and weekly contacts.

Recommendation #21: Multidisciplinary teams should be developed which include representatives of clinical, medical, youth service officers, educational, recreational and case management, with the clinician as team leader. The teams would be responsible for developing and implementing a treatment plan for each child and monitoring progress. All members would be entitled to shared access to information and weekly communication would be required.

Agency response: Cases are now being teamed weekly in each cottage with staff from all disciplines represented. Clinical social workers are now assigned to each cottage with their offices physically within each cottage to allow for better access to and communication to the children.