The Department of Children and Families (DCF), established by Section 1 of Chapter 18B of the Massachusetts General Laws, provides services to children 0 through 21 years old who are at risk or have been victims of abuse or neglect, as well as their families. According to its website, DCF “is charged with protecting children from abuse and neglect and strengthening families.” DCF’s services include adoption/guardianship, foster care, housing stabilization, family support and stabilization, adolescent services, protective services, and other in-home supports to reduce risks to children (see Appendix A). During our audit period, the department administered its services from a central office in Boston and four regional offices administered by regional directors who oversee 29 local area offices. In fiscal years 2014 and 2015, DCF served an average of 44,919 and 51,822 children under 18 years old each month, respectively. DCF had an annual appropriation of approximately $827 million for fiscal year 2015 and an annual appropriation of approximately $908 million for fiscal year 2016.
Children are referred to DCF for services in several ways. Section 51A of Chapter 119 of the General Laws requires professionals whose work brings them into contact with children to notify DCF if they suspect that a child is being abused and/or neglected. This law designates these professionals “mandated reporters,” and they are required to make an immediate oral report and a subsequent written report to DCF when, in their professional capacity, they have reasonable cause to believe that a child under the age of 18 is suffering from abuse and/or neglect. DCF’s guide Child Abuse and Neglect Reporting: A Guide for Mandated Reporters states, “When DCF receives a report of abuse and/or neglect, called a 51A report, from either a mandated reporter or another concerned citizen, DCF is required to evaluate the allegations and determine the safety of the children.” DCF does not move forward with an investigation if the issues reported are not considered abuse or neglect or if the abuse was by someone who was not a caregiver of the child. DCF also may not move forward with a new investigation if it is already aware of issues with the family in question. If the report is considered to have merit, DCF conducts what is called a 51B investigation. If DCF determines, as a result of this investigation, that the child is or has been abused or neglected, the 51A report is considered supported, or substantiated. For children who are in immediate danger of harm, DCF can file a care and protection case in the Juvenile Court and request that a judge order the child’s immediate removal from the household. Children/families also come to DCF’s attention from other sources besides 51A reports, including cases referred by the Juvenile Court, cases referred by the Probate Court, instances of babies surrendered under the Safe Haven Act, and parents’ or other relatives’ requests for DCF services.
When a child is removed from a household, DCF develops a service plan to provide a long-term stable resolution as soon as possible. According to its Guide for Foster and Pre-Adoptive Parents, DCF develops and works with three types of families to provide foster care:
- Kinship Family: A licensed family (i.e., one approved to care for children who are in the custody of DCF) that includes those known to the child who may be related by blood, marriage, or adoption or may be no relation to the child, but have family ties based on culture, affection, or family values.
- Child Specific Family: A licensed, non-kinship family or person, such as a schoolteacher or a friend’s parent.
- Unrestricted Family: A person or family, unknown to the child, that has been licensed by DCF to provide foster/pre-adoptive care for a child and that can best meet the child’s needs and maintain the child’s connection to his/her community and culture.
During fiscal year 2016, on average, approximately 8,981 children under the age of 18 were living in foster care or some type of residential facility each month.
Section 5 of Chapter 18C of the General Laws states that agencies, such as DCF, must inform the Office of the Child Advocate (OCA) when a critical incident has occurred. Section 1 of Chapter 18C of the General Laws defines a critical incident as follows:
(a) a fatality, near fatality, or serious bodily injury of a child who is in the custody of or receiving services from the executive office of health and human services or 1 of its constituent agencies; or (b) circumstances which result in a reasonable belief that the executive office of health and human services or 1 of its constituent agencies failed in its duty to protect a child and, as a result, the child was at imminent risk of, or suffered, serious bodily injury.
A “near fatality” can only be designated as such by a hospital staff member and requires that the hospital staff member determine that a child has a life-threatening condition as a result of physical abuse, sexual abuse, or neglect.
Until July 2016, Section 1 of Chapter 18C of the General Laws defined “serious bodily injury” as follows:
Bodily injury which involves a substantial risk of death, extreme physical pain, protracted and obvious disfigurement, or protracted loss or impairment of the function of a bodily member, organ, or mental faculty.
Subsequently, the law was amended to include “serious bodily or emotional injury” (emphasis added):
An injury which involves a substantial risk of death, extreme physical pain, protracted and obvious disfigurement or protracted loss or impairment of the function of a bodily member, organ or mental faculty or emotional distress. [Emphasis added.]
This change was made in order to be more inclusive of children’s mental health.
If DCF determines that “in the best interests of the child, based upon safety, well-being and permanency of the child and the child’s individual needs” the child needs to be placed outside his/her home, the child is placed in one of the following types of DCF-contracted or DCF-operated setting:
- foster care, which includes kinship families, child-specific families, family foster care homes where a child has previously been placed, and/or family foster care
- shelter/short-term programs or group care (“congregate care”), which include short-term placements for emergency situations or assessment, called Stabilization and Rapid Reintegration Programs; group homes for children who need specialty care; and long-term residential placements for children who need a higher safety level than a foster or group home can provide
- community residential care facilities, which are a form of substitute care that provides planned, temporary care in a licensed or approved residential facility 24 hours a day
The graphs below represent the number of children under 18 years old in DCF out-of-home settings each month of the audit period.
When an incident occurs at one of these out-of-home locations, DCF’s Special Investigation Unit is responsible for reviewing the details of the incident and determining whether to screen it in (if it meets DCF’s criteria for suspected neglect or abuse) or out (if it does not meet these criteria). Specifically, when an incident meets DCF’s internal definition of a critical incident,1 the DCF area director in the area where it occurred completes an internal Critical Incident Form and forwards the form to the regional and/or central office for further review and potential OCA notification. The central office reviews all the area’s Critical Incident Forms, makes a final determination of whether each incident meets the statutory definition of a critical incident and should be screened in, and notifies OCA if an incident does meet that definition.
DCF’s FamilyNet System
DCF’s website describes its FamilyNet system as follows:
[FamilyNet] is a statewide automated child welfare information system that was implemented in February, 1998. This management information system is used for virtually all DCF activities, including intake, investigation, assessment, clinical/case management, adoption, financial, legal and provider services.
i-FamilyNet is the Web-based version of FamilyNet. i-FamilyNet files include information about the nature and extent of a child’s abuse and neglect and the child’s foster-care family history, but does not contain a dedicated critical incident report field. Therefore, the audit team did not rely on i-FamilyNet data for analysis purposes; this system was used only as corroborative evidence for researching critical incidents. For example, i-FamilyNet retains a history of addresses for both children and adults involved with the agency and maintains a placement history for all children in out-of-home placement. The aggregate and case-specific data available from this database can be accessed by DCF personnel through reports, through extracts, and directly online. Others, such as employees of residential facilities, can enter incident reports in i-FamilyNet, and OCA employees can review cases but not enter data.
Medicaid Management Information System
The Medicaid Management Information System (MMIS) is the claim-processing and data warehouse system used by the Commonwealth’s Medicaid program (MassHealth) and its Children’s Health Insurance Program. MMIS contains various types of information, such as healthcare information on services provided to MassHealth members and billing submission data, and is used for processing data, verifying eligibility, and running reports that identify medical treatment. During our audit period, DCF was able to access MMIS data for children in its care.
Referrals to District Attorneys
When DCF determines that a 51A report meets the conditions that require a district attorney (DA) referral,2 it is required to report this to the DA’s office that covers the geographic area where the incident took place and the DA’s office for the area where the victim resides (if different), according to Section 51B of Chapter 119 of the General Laws.3 According to DCF’s District Attorney Referrals Policy, DCF’s notification to the DA “may be by telephone and must be followed by a written referral.” Additionally, within 30 working days, DCF meets with a social worker, a representative of the DA, and at least one other person outside DCF and the DA’s office to discuss what actions have been and should be taken.
Fatality Review Reporting Process
According to Section 13.01 of Title 110 of the Code of Massachusetts Regulations (CMR),
[DCF] shall have a Case Investigation Unit (C.I.U.) within the Central Office of the Department. The C.I.U. must conduct internal reviews of all Department and contracted casework provider agency cases involving the death of any child who was:
(a) a member of a family with an open case; or
(b) a member of a family being investigated as a result of a M.G.L. c. 1 19, § 51A report received prior to the child’s death; or
(c) a member of a family who had an open case within the six months preceding the child’s death; or
(d) a member of a family who had a supported 51A report, but a case was not open for services, within the six months proceeding [sic] the child’s death.
According to 110 CMR 13.02(4), at the conclusion of the investigation, the Case Investigation Unit is required to submit a final written report to the DCF commissioner for a review for accuracy and approval within 30 calendar days, unless the death was determined to be of natural causes, in which case the report must be reviewed by the DCF commissioner and submitted to OCA within 60 calendar days.
Additionally, according to 110 CMR 13.02(4),
The report may contain or address recommendations and/or comments covering a range of issues including: commendable or deficient casework practices demonstrated in the case, compliance with existing regulations and procedures, the need for new or revised policies or procedures, operational and administrative issues, etc. . . . The report shall include a narrative of the facts of the case based upon the information gathered by the C.I.U.
OCA was established by Section 2 of Chapter 18C of the General Laws, which states,
There shall be an office of the child advocate which shall be independent of any supervision or control by any executive agency. The office shall:
(a) ensure that children involved with an executive agency, in particular, children served by the child welfare or juvenile justice systems, receive timely, safe and effective services;
(b) ensure that children placed in the care of the commonwealth or receiving services under the supervision of an executive agency in any public or private facility shall receive humane and dignified treatment at all times, with full respect for the child’s personal dignity, right to privacy, and right to a free and appropriate education in accordance with state and federal law.
In accordance with Section 3 of Chapter 18C of the General Laws, the Child Advocate, who oversees OCA, is selected and appointed by the Governor from three nominees recommended and submitted by a nominating committee. This committee has 14 members from various public and private organizations whose purposes are directly in line with OCA’s. OCA’s mission, according to its website, is “to ensure that every child involved with state agencies in Massachusetts is protected from harm and receives quality services.” The Child Advocate is appointed by the Governor to serve a four-year term but stays in office until a new Child Advocate is appointed.
|Date published:||December 7, 2017|