Report 2018-126 Recommendation 13 Responses

Report 2018-126: Los Angeles County Department of Children and Family Services: It Has Not Adequately Ensured the Health and Safety of All Children in Its Care (Release Date: May 2019)

Recommendation #13 To: Los Angeles County Department of Children and Family Services

To strengthen and improve its quality control processes, by November 2019 the department should establish a mechanism to identify and address case management problems that are prevalent and persistent among social workers, supervisors and regional offices.

1-Year Agency Response

In January 2020, the Department's CQI Division placed Quality Improvement Specialists (QISs) in each regional office and specialized case management programs. The CQI Division's enhanced referral review process began department-wide on February 3, 2020. In addition to conducting referral and case reviews, the QISs are responsible for sharing review findings with office leadership and staff to help each office identify and address systemic and regional case practice improvement opportunities.

In an effort to further target identified improvement areas, the CQI Division works collaboratively with its partners (e.g., Risk Management Division (RMD), CPM team, Training section and Policy section) to design protocols and train QIS staff on facilitating Lessons Learned modules at all regional offices. The modules are based on lessons and insights gleaned from evaluations and assessments in regional offices and special programs across the Department. The CQI and RMD team began offering co-facilitated Lessons Learned briefings for regional offices in February 2020. As an added support, QIS managers also attend monthly regional office leadership and general staff meetings to share key points from Lessons Learned.

The CQI Division began publishing a quarterly Lessons Learned bulletin in April 2020, which provides feedback to all staff on practice highlights from that quarter. It also sheds light on opportunities for improvement identified through the CQI Division's completed case reviews.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

The department has revised its Case Review Tools to include a qualitative summary of the cases it reviews. As part of this qualitative summary, the department identifies systemic, policy, and practice concerns in the cases it reviews. The department then tracks the prevalence of those concerns and recommends solutions to address those concerns.

6-Month Agency Response

In advance of the creation of the Continuous Quality Improvement (CQI) Division, as part of DCFS' efforts to initiate a mechanism to identify and address case management issues that are prevalent and persistent among DCFS social workers and supervisors, in August 2019, the Department assigned a CQI Antelope Valley (AV) Strike Team to begin completing 100 case reviews and referrals for the two AV offices. These reviews, which were successfully completed in September 2019, included an assessment of the reviews conducted by supervisors at the regional offices and examined a number of practice elements. The reviews also evaluated the roles of supervisors and managers and identified case management issues to assist DCFS management in addressing the overall social work practices and outcomes for children and families within the AV offices.

Upon full implementation of the newly established CQI Division, components of the new quality review process will be utilized to enhance and/or deploy necessary system changes that will address operational issues to improve present case practices in all DCFS regional offices. Additionally, the CQI Division, in collaboration with its QI partner teams will focus on identifying systemic and regional practice improvement opportunities, which may include staffing level, span of control, and other human resource elements impacting practice. This will inform DCFS management in their monitoring of the number of staff in various positions, net staffing changes, vacancies, SCSW span of control, caseloads and the number of Emergency Response referrals open beyond the statutory 30-day State timeframe.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

Upon establishment of the CQI division, the division's managers will evaluate the referral/case review tools in use and build in, as necessary, additional components that examine the Children's Social Worker (CSW) and Supervising Children's Social Worker (SCSW) practices on investigations and casework.

The Department's goal is to have the CQI division align the teams that conduct referral/case reviews together, so collaborative evaluations and collective analyses will help identify practice strengths, systemic barriers, areas to strengthen, and skill development targets to improve overall social work practices and outcomes for children and families. The Department is assessing the feasibility of designating two Quality Improvement (QI) team members for each regional office and have multiple referral/case reviews occurring continuously at any given point in time, to help identify real-time solutions that address regional practice issues. Having the local QI teams will create opportunities for ongoing feedback, support, training, and coaching for CSWs and SCSWs and strengthen the CQI division's ability to monitor the implementation of strategies and resolutions for identified needs.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2018-126

Agency responses received are posted verbatim.