2004 Annual Report

 

MISSION AND PURPOSE OF THE OFFICE OF THE CHILD ADVOCATE

Mission

In 1995, the Connecticut General Assembly created the Office of the Child Advocate (OCA) to serve as an independent voice for children; to oversee the care and protection of Connecticut’s children; to advocate for children’s well-being; and to ensure that all Connecticut’s children receive the care and support they need.

Purpose

The Office of the Child Advocate monitors and evaluates public and private agencies that are charged with the care and protection of children.  OCA reviews state agency policy and procedures to ensure that children’s rights are protected and that their best interests are being served. 

Actions

The Office of the Child Advocate does not administer programs, nor does it work within limited confines.  Rather, it has a broad statutory mandate[1] directing OCA to:

• Advocate for children at risk

• Tackle public policy issues concerning juvenile justice, child care, foster care and treatment

• Review and oversee individual cases, investigate complaints, and actively intervene on behalf of children

• Educate and inform the public of laws and services affecting families and children who are placed under state supervision

• Coach/Guide(Train) and support families, concerned citizens and agencies to “navigate” public service and information systems and to meaningfully advocate for children

• Review and report on facilities and procedures of public or private institutions or residences where juveniles are placed

• Assess the population and circumstances of children with special health care needs and resources available to them

• Facilitate change by bringing different agencies together to find creative solutions to difficult problems

PRIMARY ACCOMPLISHMENTS

REPORTING PERIOD JULY 1, 2003 THROUGH JUNE 30, 2004

The statutory mandate and the accomplishments of OCA fall into four categories:  Advocacy, Ombudsman Activities, Public Policy and Community Outreach.

I.       ADVOCACY

Pursuant to Connecticut General Statutes §46a-13l(a)(1), (2), (4) and (5), the Child Advocate shall

Evaluate the delivery of services to children by state agencies and those entities that provide services to children through funds provided by the state . . .

Review periodically the procedures established by any state agency providing services to children to carry out the provisions of Sections 46a-13k to 46a-13q, inclusive with a view toward the rights of the children and recommend revisions to such procedures . . .

Pursuant to an investigation, provide assistance to a child or family who the Child Advocate determines is in need of such assistance including, but not limited to, advocating with an agency, provider, or others on behalf of the best interests of the child . . .

Periodically review the facilities and procedures of any and all institutions or residences, public or private, where a juvenile has been placed by any agency or department . . . [and]

Serve or designate a person to serve as a member of the child fatality review panel established in subjection (b) of this section.

Taken together, these duties form the core directive of OCA; thus, in our role as advocate, one moment finds us touching upon the intimate life of a given child and another moment finds us bearing upon the far-reaching impact of laws, policies and appropriations on all Connecticut children.

LITIGATION AND MENTAL HEALTH CARE

During the reporting period, OCA filed for and was granted intervenor status in WR v. Dunbar, Commissioner of Department of Children and Families, et.al., (Civ.No. 302CV429 (RNC)), pending in United States District Court for the District of Connecticut.  The case seeks to prevent the on-going placement of children, particularly those in need of mental health services, in large institutional settings.  As a matter of policy and in the context of this lawsuit, OCA will advocate that children should be placed in the least restrictive environment.  The lawsuit is pending.

OCA also obtained intervenor status in the case of Karen L. v. HealthNet (Civ.No. 3:99CV2244 (CFD)).  The case was brought to prevent HealthNet, an insurance carrier holding a state contract as a Medicaid Managed Care Plan, from restricting access to the most appropriate medical and pharmacological treatment.  This lawsuit was recently dismissed by the court. 

Despite the dismissal of the suit, OCA continues to monitor the issue of restrictive access to treatment and medication, as the question is one of continuing challenge for children in placement.  Specifically, in March 2004, OCA announced a comprehensive joint investigation with the Office of the Attorney General to look into the woeful circumstances of mental health services and health insurance for children, including but not limited to issues of availability, access to the most appropriate medical care, cost, and cost-shifting.  This investigation will be ongoing throughout the next several months and reflects, in part, OCA’s commitment to deal with the struggle of state systems to adequately provide mental health services for children in placement.

In December 2003, OCA found it necessary to file legal proceedings against the Department of Children and Families (DCF) for violations of civil rights, violations of the Mental Health Patient’s Bill of Rights and negligence, stemming from DCF’s parental relationship to Boy Doe and its failure to provide appropriate care and treatment for him.  As stated in announcing the legal proceedings:

We have concluded that DCF failed to protect [Boy Doe] from further harm and, in fact, failed as a responsible parent, to provide him with appropriate medical and mental health care a well as help him develop the skills necessary to achieve success in adulthood.  [DCF’s] actions and omissions were so egregious as to violate this young man’s constitutional and statutory rights.  It is [OCA’s] moral, ethical and legal responsibility to pursue legal remedy for this boy - an action that was unanimously approved by the Advisory Committee of the Office of the Child Advocate.2

This lawsuit has been commenced as Boy Doe et.al. v. Department of Children and Families, et.al. and is pending in the Superior Court of Connecticut, Hartford Judicial District.

FACILITIES FOR BOYS AND GIRLS

The statutory mandates place on OCA an ongoing and broad role and responsibility of oversight, review, and assessment.  Every issue that is identified and pursued generates investigation, every investigation generates corrective action, every corrective action generates recommendations, recommendations generate oversight, and oversight generates the identification and pursuit of new issues.  Our review and remedial efforts are ongoing and overlapping.  Closure is largely unrealistic.

Thus, OCA continues to take an ongoing and proactive role in the monitoring of congregate care, as outlined in last year’s report[2]. 

We continue to be enormously concerned about the Connecticut Juvenile Training School. The opening of that facility in 2001 generated numerous complaints, criticisms and concerns that resulted in an investigation into the quality of services, treatment, interventions and programs provided to the boys placed there.  That investigation resulted in a lengthy joint investigation and report in conjunction with the Office of the Attorney General. 

The need for this office to continue its oversight of the operation of CJTS has been previously reported in our 2003 Annual Report and the reasons have not subsided.  No DCF public facilities are subject to licensure, as are all other private congregate care facilities.  Therefore, as in the past, present and vigorous oversight of these facilities is essential.  It is of immediate concern and not an abstract worry given that in this reporting period, DCF cut funding for the Child Advocate’s monitor at the facility.  CJTS oversight continues to consume a considerable amount of OCA staff time.  Despite that, in our assessment, CJTS is still some distance from being the safe and effective facility it was intended to be.

Further, our anxiety is unabated over the lack of Juvenile Justice services for girls, following the poorly planned closing of Long Lane School in 2003. The lack of stable and reliable services and beds for girls under the care of DCF continues to challenge state systems and place girls at risk. 

OCA, together with the Juan F. and the Emily J. Court Monitors[3], has vigorously advocated for concrete and realizable short- and long-term solutions to the crisis.  We have worked closely with the Commissioner of DCF and the Director of the Court Support Services Division to forge priorities and plans to meet the needs of these court-involved girls who are forced to play a continuing game of “systems-limbo” with the State of Connecticut.  Meetings between OCA, the Court Monitors, DCF and Court Support Services began, in earnest, in July 2003.  By September 2003, OCA joined both Court Monitors in voicing frustration over the lack of progress.  We set out in writing the priorities discussed, social welfare and judicial program models available to meet the goals and priorities, and emphasizing the urgency of the circumstances.  In early 2004, OCA, now joined by the Attorney General, pressed again for some sign of forward momentum on this critical situation. 

Sadly, at the time of this reporting, there is minimal progress. There is still no secure facility for girls and there is a critical lack of treatment, foster care and home and community-based services for girls in placement and girls with mental health needs in general.  

OCA is currently involved, as well, in review of length-of-stay issues in Emergency Adolescent Shelters to determine, among other things, whether planning and placement issues are being effectively addressed and whether children’s psychological, physical safety and health needs are being met.  This review is ongoing and in the early stages. 

In addition, OCA continues to monitor and review all congregate care and children’s facilities and to intervene, where necessary and appropriate, to obtain and retain supports and services.

As of May 31, 2004, DCF reported having about 6,800 placed children.  Of those, approximately 3,400 children are in foster care and 1,100 are in the care of relatives. Half of the remaining 2300 children are in some form of residential treatment, including Safe Home settings. The bulk of the remaining 1,000 children are sprinkled throughout group home placements and juvenile justice system placements.  It bears emphasis that many of these children have complex health and developmental needs and myriad issues requiring attention.  In addition, children involved in juvenile justice frequently present with extraordinary behavioral health and social needs that often make them much more vulnerable in congregate settings.  Detention centers and other settings caring for this population remain a priority for this office.  OCA continues to respond to concerns and complaints involving child care and treatment programs and to work diligently to promote safe and effective services and supports.

CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN)

To address the mandate regarding review of placement and care of children with special health care needs, during the reporting period, OCA continued to pursue improved care and access to resources for children with special health care needs. With the belief that family support can prevent the transfer of custody to the state, OCA is an active member of the CT Family Support Council.  We provided staff support that was instrumental in the implementation of a federal grant to local family support networks; that grant supported network activities, partially funded a family support conference and a legislative breakfast.  The Child Advocate and staff have conducted several lively parent advocacy trainings.  We are a frequently used resource for information by parents and parent organizations.

OCA continues the assessment of placement options and quality of care for children with special health care needs since the 2001 report on CSHCN.  This past year OCA undertook a broad investigation of multi systems response to the needs of children with special health care needs.  This investigation takes the approach of reviewing the macrocosm of systems through the microcosm of two individual children living in foster care.  Preliminary findings of substandard care, protection, and even legal representation, prompted OCA to involve the Department of Public Health in an investigation of licensed care professionals; the DCF to request a full family systems review; and provide a specialized seminar to attorneys representing children with special health care needs.  A public report is expected in the coming year.

CHILD FATALITY REVIEW PANEL

The Child Advocate continues to serve as chairperson of the Child Fatality Review Panel (CFRP).  Staffing of CFRP and the day-to-day work of the Panel is through OCA.  The Panel investigates unexpected or unexplained child fatalities, identifying risks to children and advocating for systems change and prevention strategies. 

CFRP’s Annual Report covers the October 1 through September 30 period and reference should be had to both prior reports and its upcoming report for the October 1, 2003 through September 30, 2004 period for a comprehensive understanding of the issues and scope undertaken by the Panel. 

While all child deaths reported to the Office of the Child Advocate (OCA) are reviewed, thorough investigations are conducted only into those situations where there are indications of possible public systems failures.  The purpose of these investigations is to determine whether public agencies and professionals who are responsible for the care and protection of children can do a better job and to identify opportunities to improve practice.  Specific recommendations are made in each investigation.  Thus, on February 18, 2004, the CFRP released its report of the in-depth investigation of the death of Makayla K., whose teenage death from alcohol intake and the use of the drug Ecstasy exposed a child whose mental health needs fell through the cracks of public systems and private providers.  This forty-four page report made extensive findings and recommendations directed at the education system, health care professionals, public safety officials, and policymakers.  The report addresses the void in anticipatory health care guidance for at-risk adolescents as well as the treatment needs of families coping with adolescents who are at-risk for substance abuse and other risky behaviors.

During this reporting period, OCA began a ten-year review of child fatalities, with the idea that data over such an extensive period of time might have something to teach us.  We found, instead, that the data itself does not support the discovery of patterns, consistencies, or blueprints for understanding these tragedies, as each investigating agency understandably asks its own questions, for its own reasons, and in its own way.  For example, accidental deaths tend to generate much less information and the data associated with homicides and suicides tends to be uneven and disparate.  If resources permit, OCA is considering collaborating with those agencies that generate the bulk of child fatality data to consider the issues of common parameters which over a period of time might generate meaningful information.

PUBLIC SCHOOL SPECIAL EDUCATION PROGRAMS

During the reporting period, OCA has received numerous complaints about the delivery of special education services and the safety and well being of children in schools.  We are currently engaged in several active investigations covering aspects of the conditions of care in various programs.  Issues are very complex in these matters, often involving questions of federal and state law and always involving children with complex conditions in complicated social and educational situations.

OCA has and will continue to advocate for equal quality and quantity of program content and for the safety of children in state educational programs.

II. OMBUDSMAN

Pursuant to Connecticut General Statutes §46a-13l(a)(3), the Child Advocate shall:

Review complaints of persons concerning the actions of any state or municipal agency providing services to children and of any entity that provides services to children through funds provided by the state, make appropriate referrals and investigate those where the Child Advocate determines that a child or family may be in need of assistance from the Child Advocate or that a systemic issue in the state's provision of services to children is raised by the complaint.

It should be noted that in both our advocacy and ombudsman roles, OCA continues work to refine our database and its usefulness to our mission and the mission of other agencies providing services to children.  This work is largely driven by the number of calls received by the OCA in its Ombudsman capacity; that is, in its oversight and resource role for any adult or child seeking state services for children in any of the systems (e.g. child welfare, mental health, education, juvenile justice) run by the state.

In its Ombudsman role, OCA tallied over 1500 telephone calls during the reporting period[4].  Those calls resulted in over 2000 referrals to other agencies, systems or information sources.5  Approximately 360 cases were opened for investigation, oversight or follow-up.  This brought the total to approximately 500 open, active cases at OCA.

There are four Assistant Child Advocates and one Associate Child Advocate.  One of those five positions is assigned full-time to intake; that is, it is that individual’s responsibility to serve as the front-line Ombudsman, to take the calls, concerns and complaints, make the assessment to provide information and/or refer to another system, and/or to investigate as an open OCA file, as needed.  Another of the five positions deals exclusively with DCF facilities.  One-half of another position is dedicated as the staff member to the Child Fatality Review Panel. Thus, we are able to dedicate about 2.5 FTEs to handle our on-going caseload of 500 open matters.  Needless to say, there is no way to participate in these matters actively and effectively without also participating individually.  The vast majority of these open files are handled, literally, on a case-by-case and hand-holding basis, resulting in enormous staff commitments of resources and time.  It cannot be stated often enough that each of these “matters” represents a child who has likely fallen through the cracks of Connecticut’s state systems.  Furthermore, it is just as likely that the children involved in these “matters” are faced with the risk of significant impact on their future and fulfillment of their life’s potential.  These are serious matters.

In September 2003, OCA, jointly with the Office of the Attorney General, released its report of its investigation into DCF Abuse/Neglect investigation practices.  This investigation was triggered by the apparent anomaly of increased calls to the Hotline accompanied by a rapid decline in the number of substantiated cases of abuse and neglect.  The investigation revealed a failed DCF system; a wide gap between its mission and attempts to meet that mission, a failure to follow its own policies and existing law with respect to abused and neglected children, a failure to properly train and communicate with its own personnel, and deep and wide systems failures on all fronts.  Sadly, recommendations echoed earlier recommendations in other earlier investigative reports, leaving the report to conclude that DCF was not undertaking the necessary steps to move in a positive direction.

III. PUBLIC POLICY      

Connecticut General Statutes §§46a-13l(a)(6), (7), and (9) require the Child Advocate to:

Recommend changes in state policies concerning children including changes in the system of providing juvenile justice, child care, foster care and treatment . . .

Take all possible action including but not limited to, conducting programs of public education, undertaking legislative advocacy and making proposals for systemic reform and formal legal action, in order to secure and ensure the legal, civil and special rights of children who reside in this state . . . [and]

Periodically review the number of special needs children in any foster care or permanent care facility and recommend changes in the policies and procedures for the placement of such children .

During the reporting period, the Child Advocate had an active and extensive legislative agenda, largely concerned with out-of-home placements, particularly in residential treatment facilities. 

OCA proposed four pieces of legislation concerning out of home placement of children.  Specifically, we proposed:

“An Act to Mandate Formal Evaluation of the Needs of Children Placed in Out-of-State Residential Facilities”, which would have required, every six months, independent evaluations of the progress of children newly placed in residential treatment; and, every quarter, independent verification that children in residential treatment for more than one year still required such restrict care.  Such evaluations were to be approved by the Office of the Child Advocate.

“An Act Concerning Reporting for Children Placed in Out-of-State Residential Facilities, which proposed regular reports from the Department of Children Families concerning DCF’s progress in reducing the number of children in out-of-state placement.

“An Act concerning clothing allowances for Children in Out-of-Home Care,” which sought specific payments for clothing on behalf of children placed in residential treatment facilities, group homes, shelters, independent living, relatives and safe homes.

“An Act to Establish Special Child Welfare Savings Accounts for Children in Foster or Residential Care”, which proposed requiring that the DCF establish child-specific savings accounts with excess funds available to children eligible for Social Security, Supplemental Security or Veterans Administration benefits.

Although none of the raised bills passed, OCA will continue to pursue legislative and practice changes for Connecticut’s children.  It should be noted that some of these legislative measures would not even be necessary in the strict sense if best practice standards were effectively implemented and consistently followed.  Therefore, OCA will continue to advocate at both the agency and legislative levels to challenge status quo practices of child welfare and to seek implementation of best practices instead.

In addition, OCA supported several pieces of legislation proposed by others. 

“An Act Concerning Performance-Based Budgeting,” called for the establishment of policies and procedures to ensure the development of a performance measurement system and a means to monitor state agency compliance.  The bill also reconstitutes the Connecticut Progress Council to develop a policy, planning and evaluation tool and a long-range vision for the state and benchmarks to measure progress toward achieving that vision. 

“An Act Concerning the Utilization of Psychotropic Drugs for Children in DCF Care” which called for safeguards for children and youth who are being evaluated for psychotropic medication and who are already taking such medications.  It called for DCF to adopt regulations substantially similar to procedures and guidelines for such administration by the Department of Mental Retardation.

In connection with the juvenile justice system, there were three bills which identified ways to protect public safety while reducing recidivism, enhancing the quality of care of youth in the juvenile justice system and achieving substantial cost savings:

“An Act Concerning Community Based Behavioral Health Programs and Services for Children in the Juvenile Justice System”

“An Act Concerning the Needs of Juvenile Status Offenders and Status Offender Violators”

“An Act Concerning the Reduction of Disproportionate Minority Overrepresentation in the Juvenile Justice System”

Although variously referred to and/or reported out of committees, the legislature did not act on any of these proposals in this past session.

In addition to the legislative agenda and as noted elsewhere in this report, OCA has worked vigorously with DCF to promote policy and regulatory changes to enhance the care received by children under the care of DCF.  For example, as noted below in connection with the “Suitcases for Kids” campaign, the Child Advocate is promoting with DCF a policy of “Child Dignity” to avoid any number of humiliating and crushing circumstances in which children find themselves when under the state’s care.

IV.    COMMUNITY OUTREACH

Pursuant to Connecticut General Statutes §46a-13l (a) (8) and (11), the Child Advocate shall:

Take appropriate steps to advise the public of the services of the Office of the Child Advocate, the purpose of the office and procedures to contact the office . . . and

Provide training and technical assistance to attorneys representing children and guardians ad litem appointed by the Superior Court

OCA maintains a high government and public profile that has proven effective in inviting public involvement on children’s issues and in educating the public.  The public is a valuable partner with OCA in identifying both broad issues affecting children and individual cases where OCA’s efforts are needed.  

In early 2004, OCA’s website (www.ct.gov/oca) came online.  The website not only provides traditional information about OCA, but provides direct links to dozens of other websites concerning children’s legal, social, medical, family and educational issues.  For those of us on this side of the digital divide, the website is an invaluable tool and resource. 

Also in early 2004, OCA began publication of its Newsletter6.  The Newsletter, “Speaking Up for Connecticut’s Children” will be published periodically in hard copy and well as online on our website.  The Newsletter outlines current topics, highlights current investigations, reports on our legislative agenda, publishes letters from children (as appropriate) and, in general, covers the activity of the office.  Subscriptions are available online or through our office.

During the reporting period, OCA framed the text and issues for the ultimate publication of a brochure, tentatively entitled “The Rights of Kids in Placement”.  The brochure is intended to be distributed to both adults and children whose lives are impacted by the judicial system, congregate housing, DCF, or the foster care system, as well as distributed to interested parties in the legislature, public school and welfare systems, and law enforcement.

The Office of the Child Advocate also completed and distributed a child welfare guide, “Protecting Our Children – An Overview of Connecticut’s Child Protection System”.  The purpose of the guide is to show how to help prevent a child from being harmed and explain the role in helping children who are already being neglected or abused.  The guide describes the systems that currently exist to help children and families in order to prevent child neglect and abuse.  It also helps with understanding the process of getting help for children who need it now.

Further, together with a number of agencies and volunteers, OCA initiated a “Suitcases for Kids” campaign in Connecticut7.  All too often, children who are taken from their homes or transferred from one facility or placement to another, carry their belongings in plastic garbage bags.  As to the belongings it is insecure, but as to the children it is humiliating.  Through the collective efforts of the City of East Hartford, Department of Corrections, DCF, Department of Public Works, Department of Administrative Services, the Judicial Branch, OCA, and volunteers from the community, over 6,000 suitcases have been amassed in Phase I of the program.  In Phase II, the suitcases are being distributed by Court Support Services Division to DCF area offices and care centers for use by children in care.  In parallel with this program, OCA is urging DCF to promulgate a policy in support of child dignity, so that these generous public and private efforts continue in the future. 

OCA plays an active role on both a formal and informal basis with attorneys who represent children.  On a day-to-day basis, we have ongoing communication with attorneys who are involved with specific cases and who need information or support from our staff.  Of note are those situations where counsel represents a child with special health care needs.

On a more formal basis, OCA plays a supporting role with the Center for Children’s Advocacy, a non-profit organization at the University of Connecticut School of Law. 

During the reporting period, the Child Advocate chaired or served on the following committees:

CT Family Support Council, Governor’s Task Force on Justice for Abused Children

During the reporting period, the Child Advocate and Staff have participated in a number of speaking opportunities and subject symposia:

National Conference on Children and the Law, address to the Conference Meeting on the Ombudsman Role of Child Advocates, Washington, D.C.

Policy Symposium on Children and the Law, sponsored by Brooklyn College Children’s Rights Program and the Association of the Bar of the City of New York, address entitled “A Voice for Children.” 

Yale School of Nursing

CT ABA Services – Representing Children with Special Health Care Needs

Connecticut Association of School Nurses

Connecticut Association of School Nurse Supervisor

Child Guidance Clinic Annual Meeting, Bridgeport

League of Women Voters and Rotary Club Lunch, Stamford

Family Support Council, Norwich

Family Support Council, Killingly

Boys & Girls Club

Yale Bush Center Lecture Services

Capitol Region Council of Churches

Educators Society