CHAPTER
12
Accountability
and the Child Protection System
Citizen
Review Panels
The
Federal Child Abuse Prevention and Treatment Act (CAPTA)
was amended in 1996 to direct the focus of its State grant
program to support and improve child protective systems
in the states.[213] The legislation authorizes an annual
award of funds to states that submit plans every five years
and meet certain eligibility requirements. One of the key
requirements of the statute called for the establishment
of Citizen Review Panels.
The
purpose of these panels is to provide opportunities for
citizens to play an integral role in ensuring that states
are meeting their goals of protecting children from abuse
and neglect.[214] Qualified citizens making up the panel
would examine state policies and procedures and evaluate
agency compliance with their State Plan on child protection.
Under
this law, Massachusetts is required to create three Citizen
Review Panels. Citizen Review Boards originated in the 1970s
as a result of state-based initiatives to review the status
of children in the foster care system. Efforts of successful
review boards have resulted in increased community awareness
and ownership of child abuse and neglect issues.
Professional
Advisory Committee
Although
the concept of citizen review of state child protective
services is still relatively new, a citizen review panel
has existed since 1984 in Massachusetts. That year, a voluntary
Settlement Agreement was crafted following a lengthy lawsuit
filed against the Department of Social Services by the Massachusetts
Committee for Children and Youth (now MCC). The suit was
filed on behalf of abused and neglected children, and their
right to be protected from harm while in the Department's
custody. One provision in the Out-Of-Court Settlement Agreement
called for an independent review board, or Professional
Advisory Committee (PAC), made up of qualified citizens.
The purpose of the committee was to provide DSS with independent
and objective feedback on child protection issues and quality
case practice so that systemic improvements could be made.
Over
the past decade, the PAC role has been less than advisory.
Until the current DSS Commissioner, Commissioner attendance
at the PAC meetings had been infrequent. An annual report
of recommendations to the Commissioner for improvements
in practice and policy, an initial feature of the PAC, has
also been dropped.
The
PAC has been designated to serve as one of the three Citizen
Review Boards required under the CAPTA legislation. It is
intended that the PAC will continue to serve as a consultant
to the Department during its internal investigation involving
the deaths of children known to DSS. The other two newly
formed Citizen Review Panels are structured in a similar
manner to the PAC, but will primarily review case records
as they relate to near fatalities. One will focus on the
review of near fatality cases where substance abuse is a
major dynamic within the family, the other on cases in which
mental illness is the presenting problem.
Discussions
with PAC members[215] suggest that the efficiency and usefulness
of PAC and the other two Citizen Review Board could be significantly
improved.
Child
Death Review Teams
In July
of 2000, legislation was enacted to establish a statewide
system of child death review teams. The teams are designed
to collect and review data on the causes of child deaths
and to recommend policies and programs aimed at reducing
preventable child deaths and injuries across the state.
The experiences of other states indicate that such data
can be successfully translated into legislation that can
save children's lives.[216]
The
law creates a state team and eleven local district teams.
Local teams, chaired by the District Attorney of each county,
will include designees from the Office of the Chief Medical
Examiner, the Juvenile Division of the Trial Court, the
Massachusetts Center for Sudden Infant Death Syndrome, the
Department of Public Health, the Department of Social Services,
a pediatric child abuse expert, as well as law enforcement
representatives and others. District teams are charged with
examining every child death in their county. It is anticipated
that accidental and non-accidental deaths will be scrutinized
in order to determine how they might have been prevented.
The
Chief Medical Examiner will head the State Team. The State
Team will include the Attorney General, the commissioner
of several state agencies, including the Departments of
Social Services, Public Health, Youth Services, Mental Health,
Mental Retardation, and the Office of Child Care Services.
Key law enforcement and pediatrician experts will also serve.
The
State Team will develop protocols to address investigation
and data collection by the district teams, and review the
number and causes of child fatalities across the state.
This data will serve to identify changes in policy and practice
to reduce the incidence of child death and injury, including
those resulting from child abuse and neglect. An annual
report to the legislature and Governor will address these
findings.
In conclusion,
successful review boards can result in increased community
awareness and ownership of child abuse and neglect issues.
Understanding the strengths, weaknesses and challenges facing
child protection systems, and translating that knowledge
into meaningful policy are significant potential benefits
of these panels. By developing effective boards, Massachusetts
can ensure that these review bodies actually fulfill their
intended mission of helping state agencies improve the lives
of the children and families they serve.
RECOMMENDATIONS
- Expand the Role of the Professional Advisory Committee
(PAC).
The original function of the PAC was to conduct reviews
of randomly selected cases and to recommend to the Commissioner
policy and practice improvements based on those reviews.
The benefits of reviewing randomly selected cases in order
to identify good practices that should be expanded or
poor practices that should be improved, has been lost
in recent years. The PAC's role has been narrowed to a
review of cases in which children known to DSS have died
from any cause, a function also served by the DSS Case
Investigation Unit (CIU) that reviews the agency's performance
in child death cases involving abuse or neglect.
DSS should reinstitute the PAC's review of randomly selected
cases. In addition, an annual written report to the Commissioner
should be issued and made available to the legislature
and the public.
- Reinstate the neutrality and independence of the
PAC.
The locations of PAC meetings should be expanded to include
other non-DSS Central Office sites. By holding meetings
in various community sites, DSS can further promote the
message that child abuse is best handled through state
and community partnerships.
The PAC should select a Chair from among its members.
Recommendations from the PAC will be perceived as more
credible if its leadership is seen as independent, i.e.,
not a DSS employee or DSS-contracting agency representative.
Recommendations for meeting locations and election of
leadership should be extended to the Citizen Review Panels,
as well.
- Provide professional quality assurance.
The sheer volume of data that is to be reviewed according
to the federal guidelines suggests that the Department
would benefit from contracting with quality assurance
professionals who are able to apply professional methods
of data gathering, examine aggregated data, and conduct
quality assurance. Case practice review should be a core
focus. In this regard, quality assurance professionals
can also help establish protocols for review and assist
the panels in their work. Case practice review, utilized
in business and in the medical field, could be applied
to child protective practice records, where complex data
cannot be reviewed easily by individuals who meet only
quarterly, and for only a few hours at a time.
- Publish annual reports of the panels' work and recommendations.
The Citizen Review Boards must submit to the Commissioner
of the Department annual reports that identify policy
and practice areas requiring agency improvements. These
reports should be made available to the legislature and
the public. The Commissioner must work actively with the
Boards to act on these areas of suggested policy and practice
improvement.
- Establish oversight by the Executive Office of Health
and Human Services.
An examination of the various review functions among the
PAC, the recently established Citizen Review Boards, and
the legislatively mandated Child Death Review Teams would
uncover redundancies in the functions of these boards,
and identify gaps in the review process. Both the PAC
and the Child Death Review Teams are charged with reviewing
child deaths in Massachusetts, though the PAC currently
focuses more narrowly on the Department's role in the
case. Near-deaths of children in child abuse and domestic
violence cases might be overlooked unless these cases
involve substance abuse or mental illness. Also, cases
that are serious, but do not reach the threshold of "near-death",
may not be included at all in the current scope of review
by any of the review bodies.
Oversight and coordination of these review teams by the
Executive Office of Health and Human Services could help
identify ways to avoid redundancies, address gaps, and
ensure uniform protocols for efficiency and quality assurance.
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Section
III: Protecting Our Children:
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