Tuesday, January 15, 2008

Prioritization for Response from Intake:

monthly article for April 2004
Prioritization for Response from Intake:
The First Safety Decision
Introduction
The Children and Family Service Review (CFSR) conducted nationally among all states includes a measure for "timeliness." This measure is associated with Safety Outcome #1 in the CFSR and is concerned with the appropriate timing for responding to a child abuse and neglect referrals based on indication that a child may not be safe. The decision that determines how soon Child Protective Services should make face to face contact with a reported child and family has been referred to as prioritization for response. The decision is concerned with judging how quickly reports of child abuse and neglect that have been accepted should be assigned for investigation and children and families contacted. The primary issue, of course, is when a child and his family is seen face to face. It is a judgment about the urgency required based on the information reported. Many states have not passed this "timeliness" measure. The CFSR process has resulted in significant study and planning concerned with intake practice and decision making generally among a number of states and specific attention to the prioritization decision concerned with timeliness and the urgency for the first contact.
The Basis for the Prioritization Decision
The determination of the urgency with which CPS must respond to reported child abuse and neglect should be based on present danger. The reason present danger is the criteria for judging the urgency for CPS response is because it exists at the highest safety threshold. Present danger is an immediate, significant and clearly observable threat to a child occurring in the present. Present danger is consistent with situations within a family or home in which a child is in the midst of being in danger. It is happening now! The danger is certain.
Timeliness
Present danger requires immediate protective intervention. But what does immediate protective intervention mean?
Since as far back as the 1970s states have identified timeframes for determining when children and families must be seen. Now, most all states have very similar timeframes for assuring timely contact. While some variation exists among states, generally response options occur as immediate which is usually 0 - 2 hours; the same day; within 24 hours; and then from 2 - 5 days. Some states require a 24 response on all referrals of child abuse and neglect. Some states allow for more than 5 days for contact on less concerning referrals. The more immediate options are identified for referrals containing more concerning, severe family circumstances. Not all states use child safety criteria in judging prioritization. You can find states whose prioritization criteria are based on state statutes concerned essentially with types and severity of abuse or neglect.
Present danger provides a behaviorally or situational specific means for judging timeliness. Based on reported information that is consistent with present danger CPS intake and screening decisions can sort through exactly what the circumstances are that endanger the child or exist as an immediate threat of danger and determine the timing of face to face contact that can assure the danger is mitigated or controlled.
Prioritization Decision Process
The process for judging the priority response out of intake is as follows:
§ Gather information from the reporter.
§ Gather any additional information available (e.g., prior agency records, police contacts, etc.).
§ Based on agency requirements (e.g., law, policy), determine if case will be accepted (i.e., screened-in) for CPS investigation or not accepted (i.e., screened-out).
§ If screened-in, apply the criteria for "present danger" The question is, given what is known from the report; does it suggest any of these conditions exist as present danger?
§ Considering present danger that has been identified, determine the necessary response time, the critical safety question at intake being urgency. (i.e., if present danger exists, how soon should a face-to-face contact be made by CPS-- to either rule out the existence of these threats or initiate protective intervention to control the threats?)
Child Vulnerability
Present danger exists only if a vulnerable child is involved. This is the first judgment that one makes in any safety assessment and, therefore, is the first judgment made related to a timely response and present danger. Young children are always considered to be vulnerable. Regardless of age or capacity the child is unable to fend off the present danger. The child may not be able to anticipate and judge danger. The child may not be able to remove him or herself from danger. The child may consciously or unknowingly stimulate threats and reactions but cannot defend him or herself.
Making the Prioritization Decision
Here we consider family conditions that exist as present danger and identify the reasonable required response time. We are considering the required times as follows:
§ Immediate refers to "leaving to make face to face contact with a child or parents within minutes of the referral - prioritization decision."
§ Within 2 hours refers to "making face to face contact with a child or parents before 2 hours has elapsed from receipt of the referral."
§ Within same day refers to "making face to face contact with the child and parents within or by the end of the same working day that the referral was received."
§ Within 24 hours refers to "completion of the face to face contact prior to the end of the working day following receipt of the report."
A response option beyond 24 hours is not a response to a present danger - safety reported concern.
When children are reported as being in a safe place the judgment about the timing of the response will necessarily have to take into account the location of the safe place, how the long the child will be in the safe place, and access that others have to the safe place.
When a referral for child abuse and neglect includes present danger circumstances it may be necessary to consider including law enforcement in the response.
Present danger may be described within referrals as related to the maltreatment being reported.
Reported Maltreatment:

Present Danger Description of Present Danger Indicated Response Description of Present Danger Indicated Response
Hitting, beating, severely depriving now The parents' mistreatment of the child is occurring concurrent with the report. The maltreatment will typically be physical, verbal or sexual in nature. Neglect that is chronic may be occurring in the present sense, but does not necessarily meet the criterion of danger. When the conditions related to neglect that is reported are severe such as would suggest that a child's physical health is in acute distress it should be considered present danger. Respond immediately.
Child has multiple, different kinds of injuries Although it is acceptable to consider this as injuries on different parts of the body as in bruises to the arms and lower legs, its intent is more accurately related to different kinds of injuries, as in a serious burn and bruising to the arms If the child is in the home respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Child has injuries to face/head This includes bruises, cuts, abrasions, swelling or any physical manifestation alleged to have occurred as a result of parental treatment of the child If the child is reported to be in the home, respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Severe to extreme maltreatment is described This maltreatment includes:
Severe: biting, injuries to head, face, genitals,; internal injuries; broken bones; oral sex, anal sex or sexual intercourse; constantly hitting; hitting or slapping the head or face; kicking; punching or blows to the abdomen; throwing or shaking; multiple injuries; diagnosable malnutrition; abandonment; consistent scapegoating; indifference, condemnation and/or rejection; serious unmet health needs/living arrangements
Extreme: cruel restraint; vicious beatings; burns; physical torture; sexual abuse accompanied by physical abuse; bizarre sexual practices; pornographic/sexual exploitation; constantly berating; double binding; verbal assault/intimidation; psychological torture; life threatening unmet health needs/living arrangements. If the child is reported to be in the home, respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Maltreatment appears premeditated There must be supporting information reported that what has been alleged is associated with and a result of a deliberate, preconceived plan or thinking which the parent is responsible for and which preceded the maltreatment event. If the child is reported to be in the home, respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Moderate-extreme maltreatment of several victims This refers to the identification of more than one child who currently is being maltreated. There is no historical context here. Additionally, one must keep in mind that several victims in chronic neglect situations who are not at danger preclude the selection of this threat.
Moderate: medical not sought; inadequate shelter; lack of supervision; significant bruising to lower extremities; fondling, exhibition or masturbation, occasional scapegoating, indifference, condemnation and/or rejection.
Severe: See above.
Extreme: See above. If the maltreatment is severe or extreme and the children are reported to be in the home, respond immediately. If the children are in a safe place or the maltreatment is moderate respond within 24 hours.
Serious report accompanied by history of reports This threat requires no qualification about the nature of the previous reports as in whether they were minor or serious. Concern is assumed and accepted when a family has a history of reports. This present danger threat should always be considered in relation to other threats when considering present danger. "Serious" is consistent with moderate to extreme maltreatment associated with a number of or some serious family difficulties, questionable protective capacities, stresses and concerning parental behavior. Depending on the nature of the serious report, respond within the same day.
Life threatening living arrangements now This is based on specific information reported which indicates that a child's living situation is an immediate threat to his/her safety. This would include the most serious health circumstances: buildings capable of falling in, exposure to elements in bitter weather, fire hazards, electrical wiring exposed, guns/knives available, etc If the child is reported as being in the home respond within 2 hours; if the child is reported as being in a safe place respond within 24 hours.
Bizarre cruelty described This qualifies the maltreatment that has been alleged and usually will require an interpretation. Such things as locking up children, torture, exaggerated emotional abuse, etc Respond within 2 hours.
Severe to Extreme maltreatment and child is accessible to a maltreater This refers to a situation such as an only caregiver, significant amounts of caregiving time, isolation from others, etc. This threat can be used to indicate current accessibility as well as anticipated accessibility in the near future‑‑such as when the child goes home from school. Accessibility is in the context of a report of moderate to severe maltreatment. Severe: See above.
Extreme: See above. Depending on the nature of the report, respond within the same day.
Present danger may be described within referrals as related to the child being reported.
Reported Child:

Present Danger Description of Present Danger Indicated Response
Parent's viewpoint of the child is bizarre/extreme This is the extreme, not just a negative attitude toward the child. It is consistent with the level of seeing the child as demon possessed If the child is reported to be in the home, respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Child is unsupervised or alone now This could involve an older child. To be a present danger, it requires a vulnerable child. The time of day, of course, is important as is the length of time the child has been unsupervised. This only applies if the child is truly without care, not someone is caring for the child and complaining that the mom is supposed to be there but isn't presently. Keep in mind the present time concept here. If the child was unsupervised last night but is not alone now, it is not a present danger. Respond immediately.
Child fearful/anxious of home situation now This does not refer to generalized fear or anxiety. Children who are described as being obviously afraid of: their present circumstance, the home situation, or a person because of a concern of personal threat would fit this threat. Information would likely describe actual communication or emotional/physical manifestation from the child's knowledge or perception of their situation. If the child is reported to be in the home, respond within 2 hours. If the child is reported to be located in a safe place, respond within the same day.
Child needs immediate medical care (any age) To be a present danger, the medical care required must be significant enough that its absence could seriously affect the child's health and well-being. In other words, if children were not being given routine medical care, it would not constitute a present danger. It should have an emergent quality. Respond immediately.
Present danger may be described within referrals as related to the parent being reported.
Reported Parent:

Present Danger Description of Present Danger Indicated Response
Parents unable to provide basic care now This only refers to those parental duties and responsibilities consistent with basic care or assuring safety. This is not associated with whether parents are effective parents now generally, but whether their inability to provide basic duties leaves the child in a threatened state. Depending on the age of the child and the nature of the unmet need, respond within the same day.
Bizarre behaviors occurring now This requires interpretation of the information referred beyond what the reporter might be saying. Unpredictable, incoherent, weird, outrageous, or totally inappropriate behaviors fit this threat. If the child is reported to be in the home, respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Parents described as dangerous Dangerous parents may be behaving in bizarre ways; however, this is intended to capture a more specific type of behavior. Information would be considered present danger here when parents are described as physically/verbally imposing and threatening, brandishing weapons, known to be dangerous and aggressive, currently behaving in attacking or aggressive ways, etc. If the child is reported to be in the home, respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Parent out-of-control now This threat may include aspects of the two preceding influences. However, this allows for capturing emotional upset or depressed people who cannot focus themselves or manage their behavior in ways to properly perform their parental responsibilities. Their actions or lack of actions may not be directed at the children, but may affect them in dangerous ways If the child is reported to be in the home, respond within 2 hours. If the child is reported to be located in a safe place, respond within the same day.
Parent under the influence of substances now Applying the present time context, this refers to a parent who is drunk or high or is consistently drunk or high all the time. The state of the parent's condition is more important than the use of a substance (drinking compared to drunk). If the child is reported to be in the home, respond immediately. If the child is reported to be located in a safe place, respond within the same day.
Parents(s)' whereabouts unknown The whereabouts of parents or adult caretakers of the child are unknown at the time report. If children are reported alone, respond immediately. If children are in a safe place, respond within 2 hours.
Present danger may be described within referrals as related to the family being reported
Reported Family:

Present Danger Description of Present Danger Indicated Response
Serious report and family isolated This is a dependent threat as some others are. In other words, this threat must be considered in relationship to other threats when assessing or deciding about present danger. This refers to both geographic and social isolation. "Serious" is defined above. Depending on the nature of the report, respond within 24 hours.
Child subject to present/active domestic violence This considers family situations in which the alleged child maltreatment is accompanied by domestic violence. The report may include an identification of presently active domestic violence and child maltreatment or a general recurring state of domestic violence that includes child maltreatment that may not presently be active. The report may describe that a child is being mistreated and that a parent is also being mistreated, thus suggesting a violent situation, which is generalized among members. Concern is heightened if both abuses are presented as occurring during the same time, and more concerning if that same time is now. (Jurisdictions may have to adjust this present danger based on what responsibility is assumed for reported domestic violence with no reported child maltreatment.) If domestic violence and child maltreatment are reported as being in progress, respond immediately. If domestic violence and child maltreatment are reported as having occurred recently or existing as a general state of family functioning, respond within 24 Hours.
Family may flee This may require some interpretation and worker judgment. Transient families, homes that are not established, families with limited possessions, etc. Under any reporting circumstances involving a child being maltreated accompanied by an indication a family will flee, then the nature of the maltreatment must be considered serious until confirmation can occur based on the initial assessment. Depending upon the nature of the report, respond within the same day.
Family hides child This should be thought of in both overt and covert terms. Observations about a child being physically restrained within the home or parents who avoid allowing others to have personal contact with their child can be considered. This may include passing a child around to other adults, relatives or different homes. Regardless of the severity of the reported maltreatment, concern must escalate when children are being hidden Respond within the same day
Serious report and situation may/will change quickly This should be considered in relation to observable or reported information, which clearly reveals what, is occurring in the family that is the source of concern. Because the situation could change rapidly (i.e. family moves, domestic violence offender will be released from jail, etc.), the opportunity to gather important information may be lost. In this sense, this does not necessarily constitute a present danger; however, it is pertinent in judging the need to respond . Serious" defined above. Depending on what is reported, respond within the same day.