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Voices Speaking

January 17, 2017

Voices from the Capitol (II): Who is Juan F. ?

Roger Senserrich

Last Friday was the last day that individual legislators could introduce bills at the General Assembly. We have been reading through proposals and working on our priority list.

Our focus this week, however, is on the Department of Children and Families (DCF) and an important hearing that will take place next week. Let´s get started. 

Spotlight: the Juan F. Settlement

In 1991, the state of Connecticut´s Department of Children and Youth Services (now the Department of Children and Families, DCF) entered into a consent decree that covers all children that are in the care, custody, or supervision of DCF due to abuse, neglect, or abandonment, as well as children the agency knows (by virtue of a report) are at risk of such maltreatment.

The consent decree was the result of the Juan F. case, a 1989 suit that challenged how Connecticut served children in state care. The consent decree established a series of benchmarks for DCF, trying to ensure that the needs of children and families under their supervision were being met. The agency has been operating under court oversight since.

In 2004, under the guidance of a Federal Court Monitor, the parties drafted a plan to exit federal oversight. This exit plan requires DCF to meet 22 measurable goals pertaining to the well-being of children in their care. Since then, DCF has slowly but steadily improved outcomes related to placement of children in care, discharging of children, disruptions in child placement, and reunification and adoption.

Last year, more than two decades later, the state of Connecticut reached an agreement to finally settle the case.

The agreement covers the following:

  • Connecticut will agree not to cut DCF´s budget.
  • The agency will still have to meet a series of goals (around items including investigations on abuse cases, social worker caseloads, case planning and outcomes, meeting the needs of children in care, and site visits) to protect and provide for children under state care.
  • The full exit plan is available here.

Why are we talking about this today? First of all, because after a quarter of a century under federal monitoring, DCF is still struggling to hit many of the benchmarks on this settlement. If we want to ensure that vulnerable children and youth under state care receive the services they need, it will require both funding to ensure that there are enough social workers to manage these complex cases and accountability.

Second, the Juan F. settlement agreement must be approved by the General Assembly - and the Appropriations Committee will be holding a hearing on this very issue Monday next week. It is important to make our voices heard.

Hearing Alert: Juan F. at Appropriations, January 23

  • The Appropriations Committee will hold a public hearing on Monday, January 23, 2017 at 10:00 A.M. in Room 2E of the Legislative Office Building (300 Capitol Avenue, Hartford.)
  • Sign-up for the hearing will begin at 9:00 A.M. in Room 2700 of the LOB. 
  • You must submit 60 copies of written testimony to Committee staff at the time of sign-up.
  • You can email written testimony in MS Word or PDF format to APPtestimony@cga.ct.gov.
  • Even if you are unable to attend the testimony in person, we encourage you to submit written testimony by email. Many legislators use this testimony when drafting arguments to present on the House and Senate floors.

Connecticut Voices for Children will testify at the hearing in favor of accepting the settlement. Although DCF still struggles to meet many of the goals set in the 2004 exit plan, the agreement will protect the agency´s funding from further cuts while maintaining oversight in key areas.

Of course, sheltering DCF from cuts could mean further service reductions in other social service agencies. We are watching to make sure this does not put children and families at further risk - like everything in the budget, it is a balancing act. We believe, however, that DCF's (slow, steady) progress and the chance to protect crucial state funding justifies our support.

If you are interested in testifying on this hearing or have any questions on the Juan F. settlement, e-mail us! Lauren Ruth, our Youth Policy Fellow, has been tracking this issue closely and will be happy to answer any questions.

This Week: Committee Meetings

Quite a bit of movement this week at the General Assembly. After the Friday rush of legislators introducing individual bills, committee members and chairs are starting to discuss what bills will be raised, and will begin to draft committee bills.

This means that this week we will see quite a few committee meetings: Public Safety today; Insurance, Labor, Higher Education, Children, and Human Services Thursday; and the Office of Early Childhood Cabinet Friday. The agenda for each meeting is usually posted the day before on the CGA website. This week, committees will be mostly voting on which bills will be drafted as committee bills and/or get public hearings.

The full schedule can be found here. We will keep you posted on any major decisions or bills to follow as we go along.

Still time to register: State Budget Forum

Next week we will convene at the State Capitol for Connecticut Voices for Children's 16th Annual State Budget Forum: "Building a Budget for Connecticut's Future."

  • WHAT: 16th Annual State Budget Forum.
  • WHEN: January 24th from 8:30 AM to 12:00 PM.
  • WHERE: Old Judiciary Room, State Capitol, 210 Capitol Avenue, Hartford.
  • REGISTRATION: please RSVP here. Seating is limited.

Participants will include Secretary Benjamin Barnes, Comptroller Kevin Lembo, and Representatives Toni Walker and Vincent Candelora, among others. Please visit our event page for more information, or e-mail Ray Noonan with any questions.

What we are reading:

With Congress taking the first steps towards repealing the Affordable Care Act (ACA), a lot of reading on what this means both for Connecticut and the country as a whole:

  • The Congressional Budget Office reports that repealing the ACA could increase the number of uninsured Americans by 32 million in 10 years, while causing insurance premiums to double over that time. Here is the report; here is the NYT article on this subject.
  • The Center on Budget and Policy Priorities estimated the cost for each state of an ACA repeal. For Connecticut it would mean 248,000 people losing insurance coverage by 2019. Here is the report; here is a good overview at the CT Post on this issue.
  • The ACA repeal could also have a significant impact in the economy. According to a Commonwealth Fund Study, Connecticut would lose 36,000 jobs and billions of dollars on economic output. Nationwide, the repeal would lead to the loss of 2.6 million jobs. Here is the full report.
  • Silver lining: a majority of Americans now think that the ACA is a good idea
Issue Areas:
Child Welfare, Family Economic Security
Tags:
DCF, Juan F., Voices from the Capitol
October 16, 2018

Meeting the Complex Needs of Youth in State Residential Facilities

Stephanie Luczak, LMSW and Lauren Ruth, Ph.D.

The needs of youth who have experienced multiple traumas are complex and impact their physical health, education, behavioral health, and family stability. Children who have complex needs easily fall through systemic cracks or experience unmet needs.

On September 26th, 2018, the Connecticut Office of the Child Advocate (OCA) released a report regarding the state-run Psychiatric Residential Treatment Facility at the Albert J. Solnit South Center Campus (Solnit S.). Three months prior, a 16-year-old, known as Destiny, died by suicide in the facility. Destiny was both pregnant and in in the care of the Department of Children and Families (DCF) at the time of her death.

The OCA report and a subsequent legislative informational hearing provided insight into three main systemic issues:

  1. Adolescents, particularly those with a history of trauma and those committed to DCF, have complex mental health needs. The systems that serve these youths must be equipped to adequately serve those needs.

  2.  The assessment and monitoring of residential facilities for youth, including Solnit, must promote increased transparency, timely reporting, public access to these reports, and be an ongoing practice.

  3. There is a need for a legislative oversight council to help facilitate accountability, improve policy and practice, and increase cross-agency coordination to improve outcomes for children and their families.

The OCA report examines a brief timeline of events leading up to Destiny’s death, including Destiny’s historical trauma and presenting mental health needs, and identifies several risk factors that were present at the time of Destiny’s admission to Solnit S. It also provides an in-depth look at the systemic issues that increased youths’ risk of attempting suicide at Solnit, including Destiny, as well as seven other attempts that occurred between November 2017 and July 2018.

The report states that Destiny experienced the trauma of maltreatment during early childhood, after which guardianship was transferred to a relative when she was two years old. Experiencing childhood trauma increases the risk of negative lifetime impacts including suicidal thoughts and behaviors. A 2013 literature review examined several studies that explored the relationship between child maltreatment and adolescent suicidal ideation and attempts. The 2013 article determined that there is a clear link between childhood sexual abuse, physical abuse, emotional abuse, and neglect and suicidal thoughts and behavior (p. 12-13). While the harmful impacts of trauma compound with exposure to new traumas, clinical interventions, increased social support, and positive coping mechanisms can successfully decrease suicidal ideation among adolescents who have been maltreated (p. 22).

Destiny was committed to DCF in October of 2016 when her mental health needs exceeded her caregiver’s capacity. From that date until her commitment to Solnit S. in February of 2018, she moved frequently from place to place including a group home, a foster home, and multiple stays in congregate care (p. 19-20). Separation from caregivers, such as when children enter foster care, is a traumatic experience that has been linked to increased risk for depression and other psychopathologies including suicidal ideation and behaviors. Youth.gov, the federal website that promotes effective youth programs and resources, reports that: “children in foster care were almost three times more likely to have considered suicide and almost four times more likely to have attempted suicide than those who have never been in foster care.”

Destiny attempted to end her life in September of 2016, one month prior to entering DCF care. Prior to her admittance to Solnit S., Destiny had expressed suicidal ideation multiple times, as stated in the DCF record (p. 20).

Although the American Foundation for Suicide Prevention lists previous suicide attempts as a risk factor that may increase the chance of future suicidal thoughts or behaviors, upon Destiny’s admission to Solnit S., she was “considered a low risk for suicidal attempts, self-injurious behavior or assaults” (p. 20). This was a clear miscategorization because Destiny’s history of trauma, commitment to DCF, and prior suicide attempts collectively indicate a moderate to high-level risk for suicidal behavior, according to the Columbia Suicide Severity Rating Scale (C-SSRS).

Youth suicide is a devastating tragedy that continues to be the second leading cause of death for young adults ages 15-34, both in Connecticut and nationwide. However, it is also preventable in many cases.

Suicide prevention begins with promoting a process for understanding, screening, and treating suicidal ideation and behavior, made possible through increased education and communication about youth suicide. This includes the use of consistently and regularly administration of the Columbia Suicide Severity Rating Scale (C-SSRS) across state and private agencies, in congruence with the State of Connecticut’s Suicide Prevention Plan 2020 (p. 25). The C-SSRS is a widely-used scale that screens for risk of suicide and is supported by an “unprecedented” amount of research.

The C-SSRS has been widely supported and utilized within the mental health field. However, it is unclear how the scale was administered at Solnit S. Barrins & Associates—the independent consultants hired by DCF to examine the facility. They found that “the regular use of the C-SSRS is relatively new at Solnit South, and staff may not have developed the habits that facilitate its use” (p. 19). The September 20th report from Barrins & Associates goes on to further recommend that Solnit S. should prioritize and measure compliance with the use of the C-SSRS administration and documentation. Additionally, preceding Barrins & Associates reports from September 19th and August 28th, found that “risk assessments completed on admission are sometimes confusing, the form is ineffective in determining level of risk,” (p. 6) and “the policy governing the administration of the C-SSRS is not clear and appears to be internally contradictory” (p. 4).

It is unclear how the C-SSRS is administered at Solnit S., and it is also uncertain how the facility plans for youths’ discharge. DCF Commissioner Katz pointed out during her testimony that while hundreds of cases have been successfully discharged from Solnit S., all youth who are discharged from the facility must have adequate therapeutic, educational, and social supports in place to meet their needs so that they can thrive in the community.

The OCA report provides illuminating evidence that Destiny’s discharge was not carefully planned. The report makes clear that neither mental health services nor a clear educational plan were in place or communicated to the foster placement. (p. 23). This lack of discharge planning can provide for tumultuous placement change, which is a problem that is not unique to the Solnit S. facility. During Connecticut Voices for Children’s 7th Annual Youth at the Capitol Day event, youth currently in foster care in Connecticut discussed several experiences of moves with a lack of planning. When the youth were asked about what would make the placement change process smoother, they unanimously expressed that being given more time and information makes for a smoother and more positive transition.

In addition to the recommendations proposed by both the Office of the Child Advocate and Barrins & Associates, the systemic failures, in this case, provide further support for the need of an independent, legislative oversight council to improve outcomes for children and families in vulnerable situations across the state. The OCA report identifies that although the current DCF State Advisory Council (SAC) requires DCF to report information regarding facilities, including Solnit S., no reports have been made available on the SAC website (p. 11). An independent legislative oversight council would not only increase agency oversight, but it would convene a multidisciplinary group to “monitor, track, and evaluate DCF’s policies and practices,” such as the policy of administering the C-SSRS at Solnit S., or improving the coordination of discharge planning across agencies.

In some cases, like Destiny’s, the inability to identify a need and provide services can result in tragedy. Connecticut must do better in serving children with complex mental health needs and the families who care for them. This can be done by decreasing agency silos and working more collectively to improve how our systems support children with complex needs through an increase in systemic accountability, transparency, and collaboration.

Issue Area:
Child Welfare
Tags:
DCF, mental health, trauma

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