Illinois Dept of Children & Family Services System Review

Abstract ILLINOIS DEPARTMENT of CHILDREN and FAMILY SERVICES REVIEW Purpose This proposal is a response to a request from the Illinois Department of Children and Family Services for a systems-focused review of the department by the Center for Innovation in Population Health (IPH Center) at the University of Kentucky. The project team, led by Michael J. Cull, PhD, Associate Director, IPH Center, Associate Professor, Health Management and Policy, College of Public Health, University of Kentucky, will be supported in the state by Richard Epstein, PhD at Northwestern University and Tamara Fulle, PhD at the University of Illinois, Chicago. Our approach, informed by safety science, will provide a review that differs significantly from previous reviews of DCFS. The principles of safety science challenge us to understand problems in organizations as symptoms of deeper systemic issues within complex, high-risk, interdependent systems. In aviation and other safety critical industries, safety science is the basis for systems approaches to organizational analysis. A systems approach moves beyond simply looking at each individual component in a system to focusing instead on component interaction. Rather, a systems approach is concerned with knowing whether components in a system operate as they were designed, and what properties in the system emerge from their interactions. When there are poor or unanticipated outcomes within these systems, it is unlikely to be the result of isolated actions or intentional egregious action. Rather, professionals working within the system are doing what made sense to them at the time, given their available resources, knowledge, and system constraints. Qualifications The IPH Center at the University of Kentucky is comprised of three programs—Precision Analytics, Safe Systems, and TCOM Implementation, Development, Education and Support (TIDES). The review team will leverage resources and experiences from all three programs to support the effective systems analysis of all aspects of DCFS. The IPH Center is an established hub for the Transformational Collaborative Outcomes Management (TCOM) framework that is rooted in the following guiding principles: • The belief that all interventions and assessment should be culturally responsive and respectful. • People should have a voice and choice with regard to participating in any assessments and interventions. • All interventions should be personalized, respectful and have demonstratable value to the people they serve. • Collaborative processes inclusive of children and families, should be used for all decisions at all levels of the system. • Consensus on action is the primary outcomes of collaborative processes. • Information about the people served and their personal change should always inform decision making at all levels of the system. • All of our work should be accomplished with respect to the earth and our impact on it. The IPH Center holds the rights to the Safe Systems Improvement Tool (SSIT), an assessment that organizes information, and operationalizes the TCOM guiding principles. The IPH Center and its programs has provided, or actively provides, TCOM implementation, technical assistance, and consultation services to every state in the US and a number of international partners (e.g. Singapore, Italy, England, and Hong Kong). Methods Stage 1: In Stage 1 (6 months) The IPH Center will focus on: 1) organizing the multi-site review team, 2) recruiting the advisory board, and 3) defining the structure and inter-relationships of the various functions within DCFS. This third task will be particularly important as our review will go beyond traditional reviews that may have focused on specific functions (e.g., hotline, Intact Family Services) in isolation. Analysis of functional assessment and other administrative data will begin in Stage 1 as part of our team’s process of refining the scope of the review. Stage 2: Stage 2 (12 months) will involve data analysis, synthesis of exiting materials and in-depth review of the system. Our overarching frame for this review is informed by Safety Science and will rely on a number of different methods including: 1. Analysis of existing functional assessment and administrative data 2. Journey mapping to tell the story of a families’ interactions with DCFS 3. Individual interviews and focus groups 4. The AcciMapping system mapping technique 5. Survey of agency staff Stage 3: Stage 3 (6 months) will be spent synthesizing findings and recommendations into a final report. We anticipate a series of meetings as the final report is prepared. In cooperation with DCFS a plan will be developed for disseminating the reports key findings and recommendations. Qualifications of Key Staff Michael Cull, PhD is an Associate Director in the IPH Center, an Associate Professor of Health Management and Policy in the College of Public Health and he leads the Safe Systems team. Dr. Cull has specific expertise in applying safety science to improve safety, reliability, and effectiveness in organizations. His approach leverages tools like organizational assessment (i.e., workforce surveys) and root cause analysis of critical incidents, including deaths and near deaths, to build team culture and help systems improve. Under the direction and leadership of Dr. Cull, Tennessee Department of Children’s Services was the first public child welfare agency to integrate learnings from the field of safety science into their system. This initially led to a systems-theoretical critical incident review process focused on organizational learning rather than fault-finding investigations into the workforce. The Commission for Child Abuse and Neglect Fatalities called Tennessee ‘Pioneers’ for their work. The Commission’s call for expanded use of safety science to reduce child maltreatment fatalities in its 2016 report Within Our Reach led to the establishment of the National Partnership for Child Safety (NPCS). Dr. Cull, led the movement toward the implementation and translation of safety science to the child welfare space and was instrumental in creating the NPCS. NPCS is a constituent owned partnership among 33 state, county and tribal jurisdictions across the United States that support a person-centered approach to child death reviews in child welfare. Building from foundations in safety science, the Safe System team provides leadership and technical assistance to participating sites around learning how to do collaborative reviews and identify and learn from root causes. Richard A. Epstein, PhD, MPH, is a licensed clinical psychologist and applied health services researcher whose work focuses on improving care for children and families of children who have experienced adversity, have special healthcare needs, or are involved with publicly funded child welfare and mental health services. Dr. Epstein is a Research Professor in the Mental Health Services and Policy Program (MHSPP) Department of Psychiatry and Behavioral Sciences in the Feinberg School of Medicine at Northwestern University. MHSPP supports child welfare and mental health policymakers, administrators, and private providers in their efforts to deliver and evaluate the effectiveness of programs designed to improve outcomes for the children and families they serve. Dr. Epstein oversees MHSPP’s main contract for services with the Illinois Department of Children and Family Services (DCFS) under which MHSPP faculty and staff provide technical assistance, implementation support, and program evaluation for a wide range of DCFS initiatives. Dr. Epstein also collaborates with the University of Kentucky to provide technical assistance to the Casey Family Programs-funded National Partnership for Child Safety, which is a quality improvement collaborative designed to improve child safety and reduce child maltreatment fatalities through the application of safety science and shared data, and with Vanderbilt University Medical Center to provide consultation on the development and implementation of a psychotropic medication monitoring program for the Tennessee Department of Children’s Services. Dr. Epstein’s clinical expertise is in child maltreatment and child behavioral health, and his methodological expertise is in the use of child welfare administrative data, the use of healthcare claims data, and the systematic review of existing published literature. Tamara Fuller, PhD, is Director of the Children and Family Research Center and Research Associate Professor in the School of Social Work at the University of Illinois at Urbana-Champaign. Dr. Fuller has spent her career working with families involved with the public child welfare system, first as a clinical psychologist and later as a researcher examining the effects of child welfare policy and practice on children’s safety, family relationships, and well-being. Her research interests include safety and risk assessment, predictors of maltreatment recurrence, child protective services and Differential Response, and racial disparities in the child welfare system. She has served as the Principal Investigator of two state- wide evaluation of Differential Response, one in the Illinois funded by the National Quality Improvement Center on Differential Response and one in Oregon funded by the Oregon Department of Human Services. In addition, Dr. Fuller served as the PI of the Wisconsin Department of Children and Families (DCF) Title IV- E waiver demonstration evaluation. This six-year evaluation examined the implementation and effectiveness of Wisconsin’s demonstration project, which provides 12 months of post-reunification services to eligible families with children returning home from substitute care. Dr. Fuller currently sits on several Illinois child welfare advisory committees and provided expertise on several recently enacted child welfare laws related to racial disparities. In 2022, Illinois Governor J.B. Pritzker appointed Dr. Fuller to the Advisory Commission on Reducing the Disproportionate Representation of African American Children in Foster Care. This Advisory Commission advises Governor Pritzker and the General Assembly and works with state agencies to identify the factors that contribute to the over-representation of African American children in foster care.