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DATE: |
February 28, 2023 |
21 |
SUBJECT
Title
ESTABLISH THE CHILD AND FAMILY WELL-BEING DEPARTMENT WITHIN THE HEALTH AND HUMAN SERVICES AGENCY (DISTRICTS: ALL)
Body
OVERVIEW
The child welfare system has made significant changes over the past 15 years to improve the response to children who have been abused or neglected; however, more changes can be made to move beyond the status quo. In addition, the COVID-19 pandemic elevated the need to create equity for children and families and brought to light the urgency to undertake a fundamental transformation to a better way for child and family well-being. There is an imperative need to transform the child welfare system toward prevention, with a focus on the earliest of interventions, and an overall change to a more equitable approach to reducing child maltreatment.
To support this transformation the San Diego County Board of Supervisors (Board) has taken steps to increase supports for families, promote family strengthening efforts, and reduce the impact of trauma, adverse childhood experiences, and child maltreatment. In March 2022, as part of the State of the County Address, then Chair Nathan Fletcher announced that the County of San Diego (County) will establish a new department, Child and Family Well-Being.
After coordinating with staff, the community, departmental leadership, and contractor ICF International, today’s action requests the Board’s authorization to create the Child and Family Well-Being Department within the Health and Human Services Agency (HHSA), inclusive of County HHSA Child Welfare Services (CWS), First 5 Commission of San Diego (First 5 San Diego), and additional programs and services. In addition, today’s action requests authorization to make any changes necessary to support the reorganization and partnership of CWS and First 5 San Diego into the Child and Family Well-Being Department. The creation of the Child and Family Well-Being Department provides the opportunity to integrate resources, programs, and services to support families and increase protective factors.
Today’s item supports the County’s vision of a just, sustainable, and resilient future for all, specifically for those communities and populations in San Diego County that have been historically disadvantaged and demonstrates an ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by enhancing the coordination of upstream prevention strategies and services between community resources and the child welfare system to ensure children and families receive services and supports to attain and maintain a safe environment.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Authorize the Chief Administrative Officer to establish the Child and Family Well-Being Department within the Health and Human Services Agency, inclusive of Child Welfare Services, First 5 San Diego, and additional programs and services for children and families, and reassign existing staff positions as needed.
2. Direct the Chief Administrative Officer to take any other actions to effectuate any changes necessary to implement the reorganization and partnership of Child Welfare Services and First 5 San Diego into the Health and Human Services Agency, Child and Family Well-Being Department.
EQUITY IMPACT STATEMENT
Research shows that experiencing material hardship, such as not having the resources or income to provide for basic necessities like food, clothing, and shelter, is associated with increased risk for child welfare involvement. Studies indicate that if families experience at least one material hardship, the likelihood of being investigated for neglect increases nearly three times and that if families experience multiple types of hardship (after experiencing no hardships), the likelihood of being involved in a child welfare investigation increases four times. About 60 percent of all reports to the Child Abuse Hotline are for neglect-related concerns, so prevention efforts are necessary to help mandated reporters, the community, and the workforce better define neglect/maltreatment versus economic hardship (poverty). The majority of child maltreatment reports come from mandated reporters within the education, law enforcement, medical, and mental health systems; however, many reports do not meet the definition of abuse. For example, only six percent of all reports to the Child Abuse Hotline made by school-based mandated reporters are substantiated. Economic disparities and systemic disadvantages have perpetuated disproportionate child welfare involvement among families of color and children of color are often over reported to the Hotline. The ethnic distribution of monthly averages of children in referrals for Fiscal Year 2021-22 includes:
|
Race |
Percentage Referred to CWS Hotline |
Percentage of Population* |
|
Hispanic |
45% |
34% |
|
White |
26% |
46% |
|
Black |
11% |
5% |
|
Asian/Pacific Islander |
4% |
11% |
|
Native American |
1% |
.5% |
|
Other |
13% |
3.5% |
*per 2020 SANDAG data
The statistics demonstrate the need to promote racial equity and reevaluate how current child and family serving systems respond to families with insufficient resources to meet their unique family needs.
While working to advance the child welfare system, the County of San Diego Health and Human Services Agency, Child Welfare Services (CWS) engaged youth and families, the Child and Family Strengthening Advisory Board of San Diego County and subcommittees, the foster care community, child and family advocates, CWS staff, and system and legal partners to solicit ideas and recommendations on how to achieve positive outcomes and results at a family, community, and system level. The expanded engagement provided equitable opportunities for the community to contribute to change, increase racial equity, and strengthen existing partnerships to maximize positive impact in the community. It is expected that by creating the more holistic Child and Family Well-Being Department, ethnic and socio-economic disparities can be reduced by increasing family and community partnership for children to remain safely in their homes.
SUSTAINABILITY IMPACT STATEMENT
The proposed action to establish the Child and Family Well-Being Department supports the County of San Diego’s Sustainability Goal #2 of providing just and equitable access by expanding the availability of supports and services on a continuum to all families without having to be part of the child welfare system while still maintaining those efforts to intervene and keep children safe in partnership with families when they cannot do it on their own. This action will provide the supports needed for families to gain resilience, independence, and long-term skills which will lead to a reduction in the occurrence and recurrence of maltreatment, and associated costs.
FISCAL IMPACT
There is no fiscal impact associated with today’s recommendations. The creation of a new Child and Family Well-Being Department and any proposed changes to County of San Diego reorganization may require additional resources with future fiscal impacts. The Health and Human Services Agency will return to the San Diego County Board of Supervisors for consideration and approval of any other future fiscal impacts that may result from recommendations or include in future Operational Plans as needed. At this time, there will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
This item was presented to the Child and Family Strengthening Advisory Board as an informational item on January 30, 2023 and to the First 5 Commission of San Diego on February 9, 2023.
BACKGROUND
The child welfare system has made significant changes over the past 15 years to improve the response to children who have been abused or neglected; however, more changes can be made to move beyond the status quo. In addition, the COVID-19 pandemic elevated the need to create equity for children and families and brought to light the urgency to undertake a fundamental transformation to a better way for child and family well-being. There is an imperative need to transform the child welfare system toward prevention, with a focus on the earliest of interventions, and an overall change to a more equitable approach to reducing child maltreatment.
To support this transformation the San Diego County Board of Supervisors (Board) has taken steps to increase supports for families, promote family strengthening efforts, and reduce the impact of trauma, adverse childhood experiences, and child maltreatment. In March 2022, as part of the State of the County Address, then Chair Nathan Fletcher announced that the County of San Diego (County) will establish a new department, Child and Family Well-Being.
Transformation Towards a Child and Family Well-Being System
Creating the Child and Family Well-Being (CFWB) Department will involve restructuring components of the County Health and Human Services Agency (HHSA) to better align and integrate departments and programs that serve children, youth, and families. Reconceptualizing these County operations provides an opportunity to transform the child welfare system with a focus on equity, prevention, and supporting families. The transformation will build capacity and pathways to provide families with the range of resources they need and increase protective capacity before foster care becomes a necessary intervention for keeping children safe.
In September and October 2022 County HHSA, Child Welfare Services (CWS) staff engagement feedback sessions were held to discuss the structure, purpose, and function of the CFWB Department. With the assistance and consultation of a contractor, ICF International, CWS engaged 480 staff members. Feedback included the following topics:
• Staffing, training, leadership supports, community partnerships, streamlined access to services, cultural awareness, and transparency are all necessary for success;
• Defining clear goals, purposes, and roles in partnerships are important to discuss with the community; and
• Implement changes in a thoughtful and planned way that consider impact to workload and provide transparent communication about changes.
From October to December 2022 community presentations and feedback sessions were held with CWS participants to discuss the growth and reorganization. Sessions were held in the community with supporting agencies throughout all regions of the county such as El Cajon Collaborative, Southeast Collaborative, North County caregivers support group at the YMCA, and Partners in Prevention Advisory Committee. Additional community presentations and feedback sessions will be held in early 2023.
Organizational Structure
The CFWB Department will consist of the Office of the Ombudsman, Office of Child and Family Strengthening, Administration, Office of Child Safety, and the Child Health Officer. The organizational structure is depicted below.
Office of Child Safety
The Office of Child Safety will continue to provide all programs and services currently administered through CWS. Social Workers will partner with children and families to assess the safety of children who have been alleged to have been abused and/or neglected through investigations of maltreatment allegations received through the Child Abuse Hotline. For families who have substantiated allegations of child abuse and/or neglect, Social Workers will provide case management and intervention services through either Voluntary Services cases or cases open with the Juvenile Dependency Court to either maintain the child safely in their home or effectuate reunification when it is safe to return the child home. If a child cannot return home safely, Social Workers will provide permanency and transition services to include establishing adoptions, legal guardianships, tribally approved home placements, or transitions to adulthood through extended foster care for non-minor dependent youth. In addition to those primary services, the Office of Child Safety will have support and specialty programs to identify, train, and monitor Resource Family homes.
This work will be administered through five programs within the Office of Child Safety including:
• Emergency Response functions to include all State and federal safety requirements for investigations of child abuse and neglect, while at the same time bridging families who could be best served through prevention services.
• Special Programs to include the Child Abuse Hotline, Indian Specialty Unit, Medically Fragile Unit, and foster youth who are working to achieve permanency through Adoption, Guardianship, or independent transition to adulthood.
• Ongoing Services functions to include support and services for families with an open Voluntary Services or Juvenile Court dependency case.
• Placement and Supportive Services for Resource Family Approval, Placement, and respite and other supportive services for the resource family community.
• Youth Strengthening and Shelter Programs with oversight of the 24-hour placement operations of Polinsky Children’s Center and San Pasqual Academy.
Office of Child and Family Strengthening
The Office of Child and Family Strengthening will be made up of three divisions including First 5 Commission of San Diego (First 5 San Diego), Prevention and Preservation Services, and Child Care System. Additional programs may be included in the Office of Child and Family Strengthening based on further community input and identified needs.
First 5 Commission of San Diego
In November 1998, California voters passed the California Children and Families Act (Proposition 10). This statewide ballot initiative increased the tax on cigarettes and tobacco products and created local county commissions to oversee funding decisions, known locally as First 5 San Diego. The revenue is used to facilitate the development of comprehensive, integrated services and systems that promote early childhood development from the prenatal period through age five. This work is led through various contracted partners who provide families of children birth to five years of age with comprehensive services that support the development and overall well-being and support the vision that all children ages zero through five are healthy, loved and nurtured, and enter school as active learners. All First 5 San Diego services are provided through contracted local community-based organizations with some engaging targeted populations that include, but are not limited to, refugee/immigrant families, teen parents, military connected, and low-income families.
This work is accomplished via the approved First 5 San Diego Strategic Plan 2020-2025, which is informed by an ad hoc committee made up of diverse and cross sector community stakeholders and approved by the governing Commissioners.
As part of the CFWB Department, First 5 San Diego will continue to reach families countywide by:
• Leading systems change efforts supporting the health and well-being for all children ages birth to 5 years of age in San Diego County;
• Supporting comprehensive healthy development (early identification of developmental and /or social emotional needs);
• Supporting early learning and care sites providing high-quality services;
• Serving pregnant and parenting women, caregivers, and children with intensive home visits; and
• Providing health and social service referrals for families.
Integrating the work of First 5 San Diego and CFWB Department Prevention and Preservation Services the County can more effectively layer funding, creating sustainability in programs and increasing capacity to serve more families in need.
Prevention and Preservation Services
San Diego County has long invested in resources and supports to provide prevention and family strengthening services to families. In recent years, the Board has supported multiple investments in child abuse prevention services, including:
• In partnership with the YMCA Childcare Resource Services and several other community organizations, Partners in Prevention cultivates a connected community that believes in strengthening family protective factors to decrease the likelihood of abuse or neglect.
• In response to Board direction (December 10, 2019 (10) and in an effort to reduce the number or families with a subsequent referral to the Child Abuse Hotline, CWS created the Family Strengthening and Prevention Initiative (FSPI). The FSPI includes the implementation of a partnership with 2-1-1 San Diego, which allows CWS staff to refer families, with an evaluated-out referral, to the 2-1-1 San Diego CONNECT program. Families referred to the 2-1-1 San Diego CONNECT program are able to receive support with connecting to community-based services that can assist with prevention of abuse and/or neglect.
• On July 13, 2021 (7), the Board approved development and evaluation of the Innovation in Foster Care: Cash Transfer Program for Youth At-Risk Families. Eligible families will receive monthly income subsidies for up to two years and have access to equitable opportunities to participate in supportive services. The program is intended to increase resiliency in impacted communities, promote family strengthening, and prevent child maltreatment and youth entry into foster care.
The Office of Child and Family Strengthening will continue to support existing prevention and preservation services and explore new initiatives that will build upon this work. New federal legislation, the Family First Prevention Services Act (FFPSA, 2018), indicates there is a clear direction to transform the way child welfare services are delivered by providing additional fiscal resources to support these efforts. Part I of FFPSA allows jurisdictions up to 50 percent cost reimbursement from the federal government for the provision of preventative services to families. This new form of funding distribution allows jurisdictions to provide more services to families in need. Eligible services include substance use disorder services, mental health services, in-home parenting programs, and kinship navigation services. These services are designed to prevent the need for families to ever make formal contact with the child welfare system. As these prevention services are being created within FFPSA guidelines, a large portion of them will be provided through a Prevention Hub.
The goal of the Prevention Hub is to link families to primary, secondary, and tertiary prevention services that are needed to prevent families from coming to the attention of the child welfare system and Juvenile Probation. The Prevention Hub will assess for safety concerns, determine if the youth may be at imminent risk of removal from their home, and provide a care navigator who can help link the families to formal supports based on a comprehensive strength and needs assessment. As a centralized access point, the Prevention Hub will ensure families have one point of contact to help them navigate needed prevention supports and services. This will:
• Ensure a prevention-focused infrastructure to keep children safely at home using evidence-based practices;
• Eliminate income criteria, creating opportunities to provide prevention services to more families; and
• Provide funding to support services to prevent the entry or return of youth into the foster care or probation systems.
Child Care System
It is crucial that San Diego County provides targeted, long-term, and continued child care investments that are accessible, affordable, and reliable. A few County efforts include:
• The San Diego County Child Care and Development Planning Council establishes priorities for the distribution of federal, State, and local child care and development funds and seeks and advocates for funding for child care and child development services to promote the improvement of quality in child care and development services for all San Diego County children (Ordinance No. 10494 N.S.).
• Establishment of the Child Care Workforce Investment Program, which will increase and strengthen child care provider capacity and provide equitable access to quality early childhood education and care in the region with a specific focus on Family Child Care providers (September 27, 2022 (7).
• Establishment of the Child Care Shared Services Alliance (SSA) Program. The SSA includes a larger organization to serve as a backbone agency to bring in resources for business infrastructure for a collective of smaller child care providers allowing providers to share costs and deliver services in a more streamlined way with a focus on high-quality care (September 27, 2022 (9).
• In October 2022, the Board hosted a Child Care Conference, leading to the creation of a countywide Child Care Blueprint. The Child Care Blueprint development is informed with input from cross sector stakeholders and child care advocates and will be released by April 2023.
Integrating these efforts into the CFWB Department will provide a holistic approach to enhancing and sustaining quality early care and education system in San Diego County.
Intended Outcomes
The vision is to increase protective factors to reduce the likelihood of child abuse and neglect and improve child and family well-being through strengths-based, family-centered, trauma informed and culturally responsive services. For children who do need to enter the foster care system, there must be an equal focus on the well-being of children and families and an emphasis on equity and reducing the impact of trauma that can come from the interaction with the foster care system.
While the focus will be on strengthening families and preventing children from entering the foster care system, youth who are suffering will not be ignored. Some youth will still require foster care as an intervention to keep them safe. However, this intervention should be a significantly smaller number of youth and foster care should be the last and least utilized intervention to support families. The County must increase family strengthening and prevention services, and also fundamentally shift the traditional approach to child protection and service delivery in order to eliminate disparities.
Through restructuring operations and creating a vision of a better way for child and family well-being, the short-term and long-term outcomes are listed below. After realizing the short-term outcomes the long-term outcomes are projected within two to five years.
|
Short-Term Outcomes |
Long-Term Outcomes |
|
• Increased collaboration and communication among agencies and community-based organizations to ensure families have equitable access to a continuum of prevention and strengthening services; • Reduced number of individuals on wait lists for services; • Improved protective capacity of parents; • Increased awareness of new processes to receive prevention services; and • Increased number of families accessing equitable preventative services. |
• Decreased rates of disproportionality and disparities; • Improved health and well-being equity outcomes for children, youth and families; • Increased family strength, resilience and sustainability; • Reduced child maltreatment, entry into foster care, and unnecessary Child Abuse Hotline calls; and • Enhanced sustainability of funding and programming for prevention services. |
Next Steps
After the Board’s action today, CWS and First 5 San Diego leadership will continue to work with ICF International to begin the reorganization into the CFWB Department through the following actions:
• Continue planning sessions with staff and the community;
• Receive and review the Business Process Re-Engineering Plan from ICF International which will include a detailed phased implementation plan and data to support staffing numbers and recommendations;
• Finalize the evaluation framework for CFWB Department; and
• Begin transitions and implementation starting in July 2023.
Today’s action requests the Board’s authorization to create the Child and Family Well-Being Department within HHSA, inclusive of CWS, First 5 San Diego, and additional programs and services. In addition, today’s action requests authorization to make any changes necessary to support the reorganization and partnership of CWS and First 5 into the Child and Family Well-Being Department.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego’s (County) 2023-2028 Strategic Plan Initiatives of Sustainability (Economy and Resiliency), Equity (Health and Economic Opportunity), Empower (Workforce, Transparency, and Accountability), and Community (Engagement, Quality of Life, Communications, and Partnership) by providing a strengthened child and family system that ensures the safety and well-being of children and families and supports the foster care community and Health and Human Services Agency staff.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
N/A