Report 2018-126 Recommendation 10 Responses

Report 2018-126: Los Angeles County Department of Children and Family Services: It Has Not Adequately Ensured the Health and Safety of All Children in Its Care (Release Date: May 2019)

Recommendation #10 To: Los Angeles County Department of Children and Family Services

To strengthen and improve its quality control processes, by November 2019 the department should follow through on its plan to create a quality improvement division and increase the number of cases it regularly reviews.

1-Year Agency Response

As previously reported in the Department's 6-month response, the CQI Division Chief reported on October 16, 2019. Additionally, the Department successfully recruited and filled the 28 positions dedicated to the CQI Division by December 30, 2019.

In January 2020, the CQI Division immediately began to collaborate with various sections within the Department to further evaluate its case and referral review tools.

The first reviews began in February 2020 and were completed in March 2020. These reviews consisted of 300 referrals that focused on children ages five and under, who were the subject of six or more referrals with allegations of sexual and/or physical abuse.

The second round of reviews began in May 2020 with approximately 60 referrals being completed so far, and also focused on children ages five and under with five or less referrals and allegations of sexual and/or physical abuse.

These CQI reviews supplement the reviews that regional managers consistently conduct in their respective regional offices.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

The department provided documentation that is has performed reviews of more than 300 referrals, and has a plan to continue to perform reviews of referrals.

6-Month Agency Response

The Department completed its feasibility assessment, and in October 2019, began moving forward with its plan to establish a Continuous Quality Improvement (CQI) Division. DCFS selected and hired the CQI Division Chief and she reported to this new assignment on October 16, 2019. DCFS is working closely with the County of Los Angeles Department of Human Resources to employ its phased-in approach to expeditiously recruit and fill the 28 positions dedicated for the CQI Division by December 2, 2019. Upon the complete onboarding and co-location of all CQI Division staff, each DCFS regional office will have a dedicated CQI Children Services Administrator who will be charged with conducting on-going case reviews and partnering with the regional offices and other divisions to implement improvement strategies for increasing the number of case reviews. In addition, the CQI team members will evaluate practices and identify enhancements and/or necessary system changes that address operational issues to strengthen and improve present case practices.

In advance of full establishment of the CQI Division, in August 2019, DCFS convened a CQI Antelope Valley (AV) Strike Team consisting of 7 analysts to review cases and referrals in its two Antelope Valley (AV) Offices as a mechanism for identifying and addressing case management problems that are prevalent and persistent among social workers, supervisorial, and regional offices. The AV reviews were completed as of the end of September 2019. Components of the AV model will also be deployed throughout DCFS' regional offices.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

The Department is assessing the feasibility of developing a centralized Continuous Quality Improvement (CQI) division and is in the process of obtaining the necessary County approvals to adequately staff the division. (The intent is to designate two Quality Improvement (QI) team members for each regional office to have multiple referral/case reviews occurring continuously.) The plan aligns the Office of Outcomes and Analytics (OOA), the Child and Family Services Review (CFSR) unit, and the Quality Service Review (QSR) section with the newly formed Quality Improvement (QI) section under the new CQI division. Bringing the Department's teams that conduct referral/case reviews together will allow for a division structure that supports collaborative evaluations and analyses that help identify practice strengths, systemic barriers, areas to strengthen, and skill development targets to improve overall social work practices and outcomes for children and families.

The CQI division will synthesize and circulate lessons gleaned from referral/case Summary of Findings through CQI Lessons Learned modules.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2018-126

Agency responses received are posted verbatim.