OFFICE OF THE CHILD ADVOCATE

ANNUAL REPORT

JULY 1, 2008 – JUNE 30, 2009

 

 

The Office of the Child Advocate (OCA) was established in 1995 after the tragic death of an infant in state care.  The child’s death made clear that an independent agency with the power to investigate and issue public reports was necessary to ensure the well-being of children and provide transparency to government services otherwise shielded from public view by confidentiality laws and institutionalized practices intended to protect children and families.

 

The statutory authority of the office is broad.  The OCA is mandated to:

• evaluate the delivery of services to children through state agencies or state-funded entities;
• periodically review the procedures of state agencies and recommend revisions;
• review and investigate complaints regarding services provided by state agencies or state-funded entities;
• advocate on behalf of a child and take all possible action necessary to secure the legal, civil, and special rights of children, including legislative advocacy, making policy recommendations, and legal action;
• periodically review facilities and procedures of facilities in which juveniles are placed and make recommendations for changes in policies and procedures; and
• periodically review the needs of children with special health care needs in foster care or permanent care facilities and make recommendation for changes in policies and procedures.

 

The OCA has harnessed our unique statutory and independent authority to investigate and evaluate state-funded and state operated programs and services for children, identify areas in need of attention and make recommendations to protect the rights of Connecticut’s children.  The OCA operates as the office of accountability for Connecticut’s children.

 

The operating budget for 2008-2009 was $918,014.  In February 2009, Governor M. Jodi Rell proposed fiscal and statutory changes for the 2010-2012 biennium budget which, if implemented, will eliminate the independent oversight and accountability for state funded services currently provided by the OCA.  The Governor has proposed to eliminate all staff positions except for the Child Advocate.  The amount of $141,000 and the Child Advocate position would be transferred to the Office of the Attorney General.  The OCA identifies ineffective, and in many cases, harmful expenditures of state funds for children’s facilities, programs and services.

 

The OCA identified costly and duplicative bureaucracy existing in state run and state funded agencies, institutions, programs and services for children.  In addition, the Child Advocate was a witness in investigative hearings of the Department of Children and Families conducted by the Connecticut General Assembly’s Select Committee of Children and the Human Services Committee.  The OCA called for an independent and through review of the DCF’s leadership, structure and management.  The recommendations were made after years of exhaustive and in-depth investigations of DCF practices and service delivery made by OCA which showed repeated systemic failures.  The result was the passage of legislation that would hold DCF more accountable by requiring them to adhere to more stringent reporting requirements.

 

Child Fatality Review Panel:

 

The Child Fatality Review Panel (CFRP), created within the same statutory framework in 1995, is mandated to review the circumstances of the death of a child placed in out-of-home care whose death was due to unexpected or unexplained causes to facilitate the development of prevention strategies to address identified trends and patterns of risk and to improve coordination of services for children and families in the state.  In addition, the panel has the authority to conduct in-depth investigations and issue reports with recommendations.  Those reports are provided to the Governor, the General Assembly, and the Commissioner of any state agency cited in the report, and is available to the general public.  During the past fiscal year, the CFRP reviewed unexplained or untimely child fatalities and fetal and infant deaths were reported to the Child Advocate and reviewed by OCA staff.  Of those, 142 cases were presented to the Child Fatality Review Panel for review.  Of the cases presented, 1 was determined to be appropriate for in-depth review/investigation and more than half required case follow-up.  These reviews provide important information about health and fatality risks to children, offer an opportunity to examine the effectiveness of state agencies, and advocate for system improvement and prevention strategies.  As part of this work, OCA has initiated and continued statewide anti-bullying initiatives, child suicide, and teen dating violence prevention initiatives.  In addition, during the last fiscal year, the OCA partnered with the Child Welfare League of America and the Department of Children and Families (DCF) in their review of Michael B. and other untimely deaths of children receiving DCF services.  This collaboration is founded on the understanding of the Child Advocate’s independent role and responsibilities to advocate for any system changes which may prevent further tragedies from occurring.  During this period of time, OCA also reviewed Department of Disabilities Services (DDS) weekly fatality reports and provided timely fatality data to various community groups and committees.

 

Citizen Response Activity:

 

The OCA has statutory responsibility to respond to citizen concerns or complaints regarding the provision of state or state-funded services to children.  In the reporting period July 1, 2008 – June 30, 2009, OCA documented almost 1,000 requests for assistance regarding specific children.  In addition, OCA conducted reviews of the cases of individual children in congregate care settings and institutions to intervene on behalf of these children and to enhance its systemic oversight and monitoring efforts.  OCA continues to review every significant event and critical incident reported through the DCF to identify areas and facilities needing attention and highlights troubling systemic trends for further evaluation and investigation.  Because of OCA’s broad authority regarding access to information, including subpoena authority, OCA is often the only entity with access to such comprehensive information.  The Child Advocate has used this knowledge and authority to inform and assist other oversight entities including the Governor, the Legislature and the Judicial Branch.

 

 

 

Facility and System Evaluation:

Riverview Hospital for Children and Youth (Department of Children and Families)

 

During the last year, formal monitoring of the state’s children’s psychiatric hospital, Riverview Hospital for Children and Youth, continued under a two year agreement ordered by the Governor.  The Hospital has made a good faith effort to address multiple concerns and has worked intensively to create progress in a number of areas.  The Hospital currently operates in an organized manner, has developed effective communication processes, and has improved its treatment planning, clinical review and staff development process.  However, the OCA remains concerned about the need for a more vigorous quality improvement process.  During the past year, the OCA continued to focus attention on persistent disturbing practices at Riverview Hospital involving excessive use of restrictive measures such as restraint and seclusion on children, as well as several instances of the use of pepper spray as a means of behavior control.  The Child Advocate, in partnership with the Attorney General, solicited the involvement of the federal Centers for Medicare and Medicaid (CMS) and requested that they assess the practices at the Hospital as well for compliance with federal participation requirements.  Corrective action was subsequently initiated.  While the formal monitoring of the Hospital is no longer funded, the OCA continues to maintain a significant presence within the Hospital in an effort to ensure continued progress in needed reforms and assess sustainability of the improvements to practice involving some of our state’s most vulnerable children.  Quarterly summary reports are available on the OCA website (www.ct.gov/oca).

 

York Correctional Institution (Department of Correction)

 

The OCA has continued to commit extensive staff resources to examine the pathways and conditions of confinement of youth in or at-risk for entering the adult justice system.  The OCA completed a three-year investigation and data analysis of girls involved with DCF who are placed at York Correctional Institution, the state’s only correctional facility for women.  This investigation culminated in a report (available on the OCA website) released in July, 2008 that represents the first and only comprehensive review of Connecticut’s child welfare to adult prison pipelines.  Recommendations were shared with state agency leadership and OCA will continue to advocate for needed and sustainable reforms, particularly in child welfare practices and conditions of confinement.

 

Multiple improvements in the conditions of confinement for youth in DOC custody have been noted such as enhancements to educational programming and improved access to gender and age appropriate health and mental health services.  The DOC has acknowledged the unique needs of incarcerated teens and has been working collaboratively with multiple stakeholders, including the OCA, to provide more effective services which have the potential for impacting recidivism. This work continues and the upcoming year will involve engaging new administration within the DOC as well as continuing the positive momentum.

 

State licensed/funded residential programs for children:

• Lake Grove at Durham:  For several years, the OCA and the Office of the Attorney General have collaborated to investigate allegations that the DCF has failed to adequately protect and care for Connecticut’s most vulnerable children.  A review of these investigations confirms a chronic pattern of deficiencies in leadership, program planning, service delivery and facility and program oversight at all levels of the DCF.  This was also the situation at Lake Grove of Durham.  We investigated allegations related to program deficiencies at Lake Grove at Durham, a 116-bed institution that was licensed, regulated, and utilized by the DCF to serve children with intellectual disabilities, many of whom also suffered from mental health problems related to the trauma of abuse and neglect.  The DCF placed children at Lake Grove because Lake Grove was the only facility in Connecticut to serve children with intellectual disability.  The facility was finally closed in September 2007 when DCF stopped sending children there.  The allegations against Lake Grove, and the subsequent findings of this investigation, range from health care services that created risks of serious physical harm to the children; the absence of a mental health therapeutic program; practices that ignored regulatory and professional standards of care; disrepair and unsafe conditions; and an inexperienced and poorly supervised staff.  In addition, the DCF was well aware of the problems at Lake Grove, yet failed to initiate timely and decisive action, provide ongoing oversight, child protection and enforce sustained changes.

 

• Stonington Institute:  Stonington Institute is intended to be a residential center focusing on substance abuse treatment.  It is licensed by both DCF and the Department of Public Health (DPH).  Both agencies have identified a list of concerns over a period of years.  The OCA commenced an investigation of Stonington Institute in the summer of 2008 after visiting the program and finding that children were receiving no meaningful treatment.  We identified a number of serious concerns, including inadequate medical care, lack of a therapeutic treatment milieu, extreme staff turnover, the use of involuntary medication and considerable safety concerns.  In addition, we found that DCF failed to properly oversee the provision of therapeutic progress, appropriate medical care, identify cases of staff turnover and require measures to stabilize staffing, demonstrate accountability in the expenditure of State resources, utilize monitoring as a mechanism for active evaluation that kindles change of practice or conditions, ensure the safety of all children regardless of state of origin and communicate vital information.

 

Children with Special Health Care Needs:

 

The OCA has made diligent efforts on behalf of children with complex medical conditions and developmental disabilities.  As a result of their work during the past year, diligent efforts were made to try to ensure better protection for our most vulnerable children and towards creating more supports and services.  The OCA’s advocacy for children in out-of-state placements also remained vigorous.

 

C.A.S.A:

 

The OCA and the Office of the Attorney General completed a review of Connecticut’s Court Appointed Special Advocate (C.A.S.A.) program in response to concerns expressed to both Offices.  The report found that improvements need to be made to the program, including the need to serve more children, more effective volunteer recruitment and retention, better training and support for volunteers and more effective oversight.  The report recommended that the Connecticut statute regarding the C.A.S.A. program be revised to eliminate the sole source contract for the C.A.S.A. program and require a competitive bidding process for the award of a state contract for C.A.S.A. services.  In addition, the statute should include specific language regarding minimum standards for scope of services, staff qualifications, caseload and practice standards, financial management and quality assurance.  The recommendations also include the need for the Judicial Branch to develop and implement incentives and opportunities for judicial leadership to promote a high quality, accountable program.

 

Mandatory Reporting in Public Schools:

 

In partnership with the Office of the Attorney General, OCA continued an investigation regarding compliance of public school professionals and administrators with mandatory reporting of suspected child abuse and neglect.

 

Voluntary Services:

 

This year OCA continued its review of DCF’s Voluntary Services (VS) initiative in general and on the experiences of children and families in accessing voluntary services.

 

Legislative Advocacy:

 

In the fall of 2008, the Child Advocate was called upon to testify before the legislature regarding the Department of Children and Families (DCF).  This provided an opportunity for dialogue about the many challenges facing the DCF and to offer solutions.  The Child Advocate made several recommendations for systemic improvement, foremost of which was a top-to-bottom management assessment of the Department of Children and Families.  During the 2009 legislative session, OCA was led a number of legislative efforts including legislation to implement recommendations of the 2007 Monitoring and Evaluation Report issued by the Legislative Program Review and Investigations Committee (lpric); require the Department of Public Health to license DCF facilities; and improve the Court Appointed Special Advocate (CASA) program.  OCA also actively worked in partnership with many different organizations to support legislation to improve the transition of children with mental health needs from the DCF to the Department of Mental Health and Addiction Services; ensuring educational stability for children in foster care; creating a relief fund that provides financial assistance to families whose children have excessive medical expenses; raising the age of juvenile court jurisdiction from sixteen to eighteen; and enhancing judicial oversight of child protection matters.  Finally, the Child Advocate testified regarding numerous pieces of legislation affecting children in a variety of areas including teen dating violence, mental health, health care, and education.  While many pieces of legislation fell prey to the substantial budget crisis, the legislature passed and the Governor signed Public Act 09-209, implementing the recommendations of the 2007 Monitoring and Evaluation Report issued by lpric.  The Act expands the membership and role of the State Advisory Council on Children and Families and requires DCF to develop and track the progress of a single strategic plan; report certain information regarding facilities to the State Advisory Council; and provide a written response to reports issued by the OCA within 90 days.

 

Policy Development:

 

The OCA continued to be an active participant and convener of many task forces and committees which are responsible for the development of policy that impacts the children of Connecticut.  Our collaborative involvement with other organizations and agencies reflects our commitment to improving the systems responsible for the care and protection of children.

 

Public Education:

 

OCA staff speak regularly at colleges, universities, non-profit organizations, professional associations, youth events, educational forums, conferences and at many more.

 

Teen Healthy Relationships Initiative:

 

The OCA sought and received $75,525 from CHEFA to continue its groundbreaking work on the Teen Healthy Relationships and Dating Violence Initiative.  This is a collaborative effort between OCA, the CT Youth Forum and the Institute for Community Research designed to work with high school youth to increase awareness of youth interpersonal violence, empower them to facilitate the process, and to begin to reframe and replace normative violence messaging with youth-driven dialogue and communication on healthy teen relationships.  The project culminated in a “Week of Action” media campaign with Guerilla Theater skits, posters, sets of different “business cards” each designed specifically for the scene in which they are being handed out.  “Week of Action” activities tool place in May at three target schools around the state.

 

Priorities for the 2009-2010 fiscal year:

 

1)      Review the circumstances of children under the age of six who are in congregate care.  Congregate care is problematic for all children in out-of-home care.  It is particularly detrimental for young children who need a consistent, reliable, primary caregiver and no disruption in placement.  There are currently approximately 1070 children under the age of 6 who are in out of home care (as of August 4, 2009); of that number, about 65 were in congregate care.  The OCA, in partnership with other organizations, will conduct a review of children under age six in congregate care to determine:

 

a) Whether they should be in foster care;

b) Why they are in congregate care;

c) The barriers to placement in a family setting.

 

2)      Facility Investigations.  The OCA remains gravely concerned about the circumstances of children who are placed in both DCF operated and licensed facilities.  The OCA is concerned about the quality of care, the increase in arrests, use of pepper spray at Riverview Hospital and the lack of oversight and quality improvement efforts by DCF.  In addition, Connecticut still has over 300 children who have been sent out-of-state because treatment is not available in Connecticut.  The children who are sent out-of-state are primarily children with developmental disabilities.  We will be vigorous in our investigations and will continue to vigorously advocate for appropriate services for children.

 

3)      The OCA will complete the review of DCF’s voluntary services program.

 

4)      Advocacy efforts will continue to provide more resources for enhanced home and community-based services for children with disabilities and special health care needs.

 

5)      Youth who are in the custody and care of the Department of Correction remain a high priority for the OCA.  We will continue to work with DOC to ensure that the girls at York and the boys at Manson receive the best possible care.  In addition, the OCA will enhance efforts to get DCF more involved with discharge planning and treatment planning, increase mental health services and provide for effective after-care services.

 

6)      Youth in Transition.  The OCA will continue our advocacy and efforts to focus more attention on better transition planning and implementation to help young adults reach their full potential.  The OCA will continue to advocate for DCF, DHMAS and DDS to better prepare young people for successful living in small group homes or independent living.  DCF also needs to do a better assessment of the needs of children and to provide better services and timely transition for youth.

 

7)      The OCA will continue aggressive efforts to ensure that the law which raises the age of juvenile delinquency to 18 be implemented.

 

8)      The OCA and the Office of the Attorney General are conducting a survey of licensed clinical social workers to determine whether managed care organizations are providing access to their services.  The survey will also gather information to determine ways in which access to the care of LCSW could be improved in our state.  The survey instrument has been developed with the assistance of Connecticut social workers.

 

9)      The OCA will convene a working group to access the current supports and services for children with developmental disabilities and develop a blueprint and action plan for needed development and coordination.

 

10) The OCA, in partnership with the Office of the Attorney General, will complete an investigation regarding compliance of public school professionals and administrators with mandatory reporting of suspected child abuse and neglect.

 

All of these accomplishments were achieved by the efforts of a small number of staff. OCA has highly specialized and expert multidisciplinary staff.  The staff includes master’s level nurses with expertise in maternal and child health and the care of children with special health care needs; master’s level social workers with expertise in child development, child fatality investigation, and treatment of children with disabilities; attorneys experienced with child welfare, child health, and juvenile justice; and experts in facility oversight.  Their experience in dealing with major problems-including those that routinely occur in state run or state funded entities-is critical.

 

The OCA continues to play an essential role in Connecticut by overseeing the care and protection of our children.  The OCA provides invaluable oversight and accountability at a time when our children and families need them more than ever.  The children in our state need effective and efficient delivery of services more than ever before.  The OCA is the only entity by law that is an independent authority with specialized expertise that can ensure that tax dollars are used effectively and responsibly to protect the rights of Connecticut’s children.

 

The other work of the OCA is almost limitless.  During the last year we continued work on bullying initiatives, child suicide and teen dating violence prevention.  They issued, with the Department of Children and Families, the Executive Summary of the fatality investigation of Michael B.  The work of the CFRP is a model for the country.

 

Since 1995, the OCA has been an effective watchdog of over $4 billion of state funds and state funded entities. They have identified ineffective and sometimes harmful state expenditures for facilities programs and services to Connecticut’s children.  During the last year, they continued to evaluate and uncover where children languish in unnecessarily high levels of very costly care and advocated for the discharge of those children to more appropriate and often, more cost effective programs.

 

Jeanne Milstein, Connecticut’s Child Advocate, at the invitation of Roberto Deriu, the President of the Province of Nuoro, Sardinia, Italy and the UNICEF Innocenti Research Centre, represented the U.S. at the first “Ombuds-8” event in Sardinia, Italy on June 23-27, 2009.  Ms. Milstein’s attendance at the event was funded by the Province of Nuoro.  The Summit brought together Ombudspersons and Advocates or similar independent human rights institutions from Canada, France, Germany, Italy, Japan, the Russian Federation, the United Kingdom and the United States.  The Summit focused on solving global issues with G-8 leaders.

 

The OCA continued during the last year to provide high quality, cost-effective services to the state. They have been vigilant in taking action to hold state government accountable for their state funded services to children.

Information obtained from The Department of children and families web site