Friday, August 7, 2015

Class Action Consequences: The Dangers of Measuring Quantity Instead of Quality

Child welfare systems in many states are under court monitoring or receivership. Courts became involved due to class action lawsuits, such as the one recently filed against New York City’s child welfare agency.
Obviously, these legal advocates are trying to help children caught up in these systems. However, as a social worker in the District of Columbia for five years, I was surprised to learn that court oversight often hindered my ability to help my clients.
Class action settlements often emphasize quantifiable performance, even when this is not meaningful. Moreover, some standards are poorly defined, requiring staff to waste time in unnecessary activities.
In the District of Columbia, the Child and Family Services Agency (CFSA) is operating under an Implementation and Exit Plan (IEP) approved by the court. The IEP contains 83 requirements (with associated “exit standards”) that CFSA must meet to “exit” court oversight. A few examples will illustrate the problems.
The IEP prescribes that each child in a new placement be visited four times in the first month. It seems reasonable to require more visits during the first month so that the social worker can assess how placement is going and intervene if necessary. But mindless implementation of that standard can result in absurdity.
I had a client who was temporarily placed with a new foster family because her foster parent needed heart surgery. As required, I visited my client four times in the first month in her temporary placement. The ailing foster parent made a slow recovery and my client ended up staying at the “temporary” home. When the placement was changed from “respite” to long-term, it was treated as a new placement, and I had to visit four times in that month as well!
The IEP requires that children in foster care receive a full medical evaluation within 30 days of placement. This sounds reasonable. What could be wrong with requiring a medical evaluation?
Let’s start with the fact that CFSA requires that this evaluation be provided by its own clinic. That clinic does not give immunizations, so if the child needs immunizations, she will have to receive another physical from a real clinic.
What happens if the child has already had a physical within the past year and documentation of this physical is obtained? No dice, unless that physical happened within the past month.
No big deal? Remember that the hard-working social worker or case aide is required to transport the child. Counting transportation there and back, this may take up half a day, typically more than the amount of time a social worker has to spend on each case per week. Meanwhile, the child might miss a half-day of school in order to obtain a physical that may be unnecessary or insufficient.
The IEP calls for the reduction of multiple placements for children in care. Of the youths served in foster care during a current year, 83 percent of them must have two or fewer placements.
As a result, CFSA staff are extremely reluctant to approve new placements even when in the child’s interest. I had one client who was not thriving. His foster parent provided no support or supervision, and he was alone much of the time.
When I tried to get him a new placement, I was told that he would have to stay in the home. It was more important to the agency to avoid a new placement that would hurt the numbers than it was to meet the needs of my client.
The IEP requires that all youth 18 or older have a “Youth Transition Plan” to prepare them for adulthood. A simple, useful format was replaced some time ago by a cumbersome template which contains about 20 separate Word documents.
Hysteria gripped my office when the deadline approached for documenting that all of our older teens had plans. Daily emails made it clear that this documentation was to be our top priority, ahead of things that had much more relevance to children’s lives.
Clients often were not interested in attending the team meeting that was supposed to be held to develop the plan. In one case, I had the entire team assemble three times, to be stood up by the client every time.
The existence of a written plan is much less important than other factors such as the quality of foster parenting, mental health care, and education that the client receives. But the existence of a plan is much easier to measure—and it is much easier to produce a plan than to improve the quality of services that the client receives.
I do not wish to leave readers with the idea that court supervision or performance standards are necessarily bad. If the standards are meaningful, they can be an effective method for improving child welfare systems. But meaningful standards are often ones that cannot be measured quantitatively.
The IEP contains some qualitative standards. Assessing performance on these standards requires qualitative review, which is expensive and hard to do well. Perhaps that is why agencies and courts seem to be addicted to meaningless, easy-to-measure standards that often hinder, not help, the provision of quality service.
This column was published by the Chronicle of Social Change on August 4, 2015.

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