IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

B.H., et al., Plaintiffs, v.

MARC D. SMITH, Director, Illinois Department of Children and

Family Services, Defendant.

No. 88 C 5599

Hon. Jorge L. Alonso

Judge Presiding

SUPERSEDING IMPLEMENTATION PLAN (SUPPLEMENTED)

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This Superseding Implementation Plan (Supplemented) (this “Plan”) fully supersedes and replaces all commitments and obligations set forth in the Amended and Revised DCFS B.H.

Implementation Plan (the “2016 Implementation Plan,” Dkt. 531).1

INTRODUCTION

In April 2015, this Court appointed a panel of experts (the “original panel”) pursuant to

Federal Rule of Evidence 706. Dkt. 484. The original panel was charged with responsibility for evaluating the services and placements DCFS was providing to Plaintiff Class Members with psychological, behavioral, or emotional challenges. Dkt. 484. In July 2015, the original panel submitted a Report to the Court (the “2015 Expert Panel Report”) outlining its findings and providing six recommendations for systemic change. Dkt. 490-1. This Court adopted the original panel’s findings in October 2015, subject to certain revisions proposed by the Parties, and reappointed experts (the “Expert Panel”) to assist DCFS in the development of an implementation plan for reform. Dkt. 507. The 2016 Implementation Plan was then developed by DCFS and approved by the Court in October 2016 upon joint motion of the Parties. Dkt. 531.

The 2016 Implementation Plan specified metrics and a set of child well-being indicators for tracking DCFS’s performance. Dkt. 531. It then laid out pilot programs, initiatives and actions

DCFS would pursue. After several years of implementation efforts under the 2016 Implementation

Plan, and for the reasons set forth in the Joint Motion for Approval of a Superseding

Implementation Pan, the Parties and Expert Panel now agree that DCFS’s reform strategies under the 2016 Implementation Plan have run their course, and that it is time for DCFS to pursue new and updated strategies building on lessons learned from its prior implementation efforts.

1 To the extent DCFS is renewing its commitment to obligations originally set forth in the 2016

Implementation Plan, those terms are fully restated herein to ensure clarity regarding the scope of

DCFS’s obligations under this Plan.

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This Plan sets out the next phase of DCFS’s efforts to address the recommendations in the

2015 Expert Panel Report. There are seven strategies in this Plan that are designed to interrelate and produce the combined result of improving care for all Class Members, and particularly those with psychological, behavioral, or emotional challenges. DCFS has agreed that this Plan cannot be terminated until DCFS has met improvement goals specified in three “Satisfaction Criteria”:

(i) sustained statewide improvement in achieving permanency for youth who have been in care for two years or more; (ii) sustained statewide improvement in reducing occurrences of maltreatment of children in DCFS custody; and (iii) timely provision of services and supports to a key cohort of youth whom the Expert Panel identified as having significant unmet mental and behavioral health needs and substantially elevated risk of long-term stays in foster care.

Part I of this Plan describes the conceptual framework for DCFS’s new reform strategies.

Part II sets out the seven interventions DCFS will pursue. Part III explains the leadership and organizational structure supporting DCFS’s reform efforts. Part IV describes how DCFS’s progress will be measured and evaluated. Part V details how DCFS will report its progress to the

Court and additional reporting it will provide to Plaintiffs and the Expert Panel. Part VI sets out the Satisfaction Criteria DCFS must meet before it can seek termination of this Plan. Finally, Part

VII describes the process for resolving disputes that may arise during the implementation process.

SUPERSEDING IMPLEMENTATION PLAN COMMITMENTS

I. Conceptual Structure

A. The Experimentalist Approach and Implementation Science

Consistent with the Expert Panel’s recommendation, this Plan is based on an

“experimentalist” approach to reform, meaning that instead of ordering DCFS to comply with a fixed set of solutions, the Parties have agreed to an evidence-building and accountability process.

Dkt. 801 at 16. There are three “essentials for success” under this approach. Dkt. 801 at 4. The

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 4 of 54 PageID #:7950 first is to create an enabling environment in which it is “safe” for DCFS staff to test newly conceived programs and determine whether they do, or do not, have the intended positive effect.

Id. The second is to select for expansion those evidence-supported interventions that have a demonstrated chance to succeed based on prior, rigorous testing. Id. The third is to implement those chosen interventions with adequate fidelity to the recommended design. Id. Deficiencies in any of these areas can jeopardize the success of attempted reform.2 Id.

Logic models provide the structural framework for developing and implementing reform strategies under the experimentalist approach. Here, DCFS has developed a logic model for each intervention to depict how the intervention is intended to improve service to youth. Each logic model contains: (i) a description of the population that is the target of intervention; (ii) a statement of DCFS’s underlying “theory of change” supporting planned positive action; (iii) a description of the intervening action to be taken; (iv) the comparison group or action against which the intervention’s impact will be tested; (v) a list of services, activities or products to be delivered to the target population; and (vi) specific results – in the form of outputs3 and outcomes4 – anticipated as a result of the intervention.

For each logic model, DCFS developed a work plan that sets out the “nuts and bolts” steps required to execute the reform strategy envisioned in the logic model. Each work plan contains

2 DCFS will secure expertise in the field of implementation science throughout the time this Plan is in effect. DCFS previously engaged Dr. Allison Metz, formerly of the National Research

Network (NIRN) and now a professor of practice at the University of North Carolina School of

Social Work, for this purpose.

3 These outputs may be specified services or activities, or may consist of measures of the extent to which service delivery adheres to the program model and best practice outcomes.

4 Each logic model identifies three different types of outcomes: “proximal,” which describe short-term changes in the population that are intended to result from the program outputs;

“intermediate,” which specify the intermediate processes and outcomes that link proximal to distal outcomes; and “distal,” which describe the long-term changes in the population that are intended to result from the proximal outcomes.

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 5 of 54 PageID #:7951 action steps and timelines, identifies individuals accountable for the work required, and specifies outputs that may be modified as necessary if, despite DCFS’s faithful implementation of a strategy with fidelity to the work plan and program models, the evidence demonstrates that these strategies are not achieving the anticipated outcomes or goals.5

The broad framework for reform envisioned in this Plan begins with an overarching “meta” logic model (the “Meta Model”) that identifies seven key reforms (the “Interventions”) DCFS is undertaking. The Meta Model shows the interrelation between each Intervention to generate systemic improvement.6 DCFS further has developed a separate logic model and associated work plan for each of the seven Interventions. It is expected that if implemented with fidelity, the

Interventions will build upon one another synergistically in order to change day-to-day practice in the field in a sustainable and effective manner.

B. The Meta Model

The seven Interventions comprising the Meta Model for reform are: (i) Resource

Development; (ii) Quality Family Engagement; (iii) Child and Family Team Meetings; (iv) Home of Relative Licensure; (v) Residential Monitoring; (vi) Subsidized Guardianship; and (vii)

Administrative Case Review. The following diagram depicts the Meta Model:

5 The work plans for the Interventions are intended to and will evolve over time as actions are completed and evaluated, and as strategies are honed based on those evaluations. The work plans accordingly are not incorporated as a part of the Plan itself, but rather are ancillary to it. However, DCFS stands ready to provide the Court with current versions of the work plans for the

Interventions upon the Court’s request.

6 DCFS developed the Meta Model in consultation with the Expert Panel, and it has been reviewed by a consultant having expertise in implementation science. See n.2, supra.

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(A) Reduced Maltreatment in Foster Care; (B)

Increased Permanency in 12 mos. for 24+ mos. &

(C) Decreased moves for youth w/4+ moves and psych hospitalization

(1) Improved provision of community supports for youth regardless of living arrangements (2)Improved Caseworker

Engagement lays a foundation for

CFTM as an intervention

(3) CFTM lays a foundation for identifying appropriate living arrangements and supports

(4) HMR

Licensure and (5)

Residential Monitoring improve the quality of care in these living arrangements and promote permanency

(6) Increased use of Subsidized

Guardianship to move youth to permanency when it is in their best interest to remain with their current caregiver

(7) ACR provides a feedback loop to monitor progress on quality services to children and families

1. The social and emotional wellbeing of children is best assured within the context of safe and permanent family relationships with birth parents, legal guardians, or adoptive parents who participate in the planning and delivery of individualized permanency and treatment plans crafted by child and family teams.

2. Assessing and treating the social and emotional needs of children with psychological and behavioral challenges preferably should begin at the earliest point of contact with the child welfare system and certainly no later than their removal into state custody. The process of assessment and treatment should continue regularly after the children are transitioned to permanent homes with birth families, adoptive parents, and legal guardians.

3. Services and treatments that are conducted outside the context of home and community-based settings should be temporary and delivered in the least restrictive, most normalized setting responsive to the child’s needs.

4. Promising innovations and evidence-supported practices that are translated to child welfare from related fields should first be pilot-tested for usability, and if deemed replicable, should be rolled-out in a phased approach that allows for structured implementation and evaluation of effectiveness prior to scaling the program up statewide.

The four statements surrounding the hexagons in the diagram set out the theories of change underlying the Meta Model. Those theories of change align with recommendations in the 2015

Expert Panel Report. The center hexagon sets out the core outcomes – the Satisfaction Criteria –

DCFS must achieve to demonstrate that the goals of this Plan have been satisfied. See infra at Part

VI. The text in the surrounding hexagons identifies the Interventions DCFS will be pursuing to achieve the goals of this Plan. More detailed descriptions of each Intervention are set forth in Part

III hereof.

DCFS’s Meta Model approach for this Plan is a key differentiation from the stand-alone reforms pursued under the 2016 Implementation Plan. DCFS is confident that each of the seven

Interventions, even taken independently, is focused on an important area requiring change and improvement. For example, there is no question that developing community-based resources, increasing the percentage of relative caregivers who become licensed, and improving casework

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Model. Through this Plan, DCFS will be testing whether the changes called for through each

Intervention have the combined effect of accelerating improved outcomes for children (as is expected), and what further coordination and systemic refinements may be needed to clear barriers to achieving real and systemic improvement in the way DCFS serves children. The Meta Model structure and the broad change it envisions thus feed directly into the sustained systemic improvement that DCFS must demonstrate to meet the Satisfaction Criteria for eventual termination of this Plan.

C. Piloting the Meta Model

Successful implementation requires thoughtful phasing, teaming, and continuous data monitoring in cycles. It also requires careful examination of those organizational structures that may help or hinder innovation, and which must be changed to provide the organizational capacity for addressing the challenges that accompany reform. It is essential to pilot test and evaluate proposed reform strategies so that overall effectiveness can be determined and necessary refinements to the strategy can be made before significant time and financial resources are invested in a statewide rollout.

This Plan requires that DCFS use pilot testing as part of its implementation process. Even as DCFS is beginning foundational, statewide work on all seven of the Interventions, DCFS is piloting the Meta Model by beginning intensive integrated implementation of all seven

Interventions in selected sites (the “Pilot Teams”).7 The Pilot Teams and comparison teams to be

7 The six Pilot Teams will include two DCFS permanency teams and four private provider permanency teams. Each team consists of one supervisor and approximately five caseworkers, serving approximately 60 – 75 youth. That totals to six supervisors and 30 caseworkers who collectively serve approximately 360 – 450 youth overall. DCFS has selected six comparable teams to serve as a comparison group for the pilot test.

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Part of the Meta Model pilot involves implementation of the Child and Family Team

Meeting (“CFTM”) Intervention within the Pilot Teams. DCFS currently expects all caseworkers to conduct CFTMs with youth, their families, their caregivers, and other people important to the youth in a manner consistent with DCFS’s Core Practice Model and DCFS policy.8 CFTMs, however, are not consistently conducted with fidelity to the CFTM model. The CFTM

Intervention is intended to address that by, among other things, providing Pilot Team caseworkers and supervisors with CFTM training, and providing Pilot Team supervisors with extensive coaching and support in building and applying their CFTM skills.9

As the Pilot Teams implement full CFTM practice in the Meta Model pilot, they will be expected to integrate and use the benefits and improvements offered under each of the other Plan

Interventions as well. Within their caseload they will be expected to identify youth living with unlicensed relative caregivers and use all available tools to encourage those families to become licensed. They will be expected to identify youth with mental and behavioral health needs who are struggling and to use flex funds to secure appropriate community-based services and supports needed to help the youth and stabilize the youth’s placement. When their casework is evaluated by DCFS, that evaluation will look beyond task completion and focus heavily on the quality of the caseworker’s engagement with the youth and family, and on evidence that all involved with the youth have a shared understanding of the youth’s strengths, needs, and goals.

8 CFTMs are a key component of the Core Practice Model that DCFS adopted under the 2016

Implementation Plan. DCFS has worked with the Child Welfare Group to develop an Illinois model of CFTM training. The Illinois model of CFTM training focuses on significant preparation work for the CFTM and ensuring that both the youth and the family voice are a key part of the meeting and the development of the services and supports that the youth needs. The required elements of a CFTM are described infra at n.14.

9 See discussion infra at 12-15 for a full description of the CFTM Intervention.

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DCFS fully anticipates that as the Meta Model pilot proceeds, there will be instances where

Pilot Teams encounter barriers in accessing what they need for their work. DCFS is committed to addressing those barriers, whether they take the form of service resource shortages, breakdowns in communication among departments within DCFS, deficits in availability of data, or otherwise.

Chapin Hall at the University of Chicago will perform the evaluation of the Meta Model pilot using key Intervention output and outcome data and metrics for the Pilot Teams. Ultimately, the test for success of the Meta Model will be achievement of the Satisfaction Criteria for this Plan.

II. The Seven Interventions

As noted above, each of the seven Interventions is supported by a logic model, copies of which are attached as Appendix A. Those logic models outline with specificity how DCFS intends to measure whether the Intervention is producing the results intended, what data DCFS will use to track progress under the Intervention, and various interim and long-term goals DCFS has set for progress. The summaries of the Interventions provided below are intended to provide context and a high-level overview of each Intervention.

A. Resource Development

Assessment data show that 40-45% of youth entering DCFS care experience serious psychological, behavioral, or emotional challenges at some point during their stay in foster care.

An overall higher percentage of youth with psychological, behavioral or emotional challenges currently are placed with relative caregivers and fictive kin. Meeting the needs of youth residing with families will require developing necessary supports and services in community settings. At the same time, DCFS also must improve youths’ ability to timely access services, supports and appropriate living arrangements when they cannot be served safely and effectively in family settings. The theory of change underlying the Resource Development Intervention is that enhancing the capacity of community and home-based placements and services will increase

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 10 of 54 PageID #:7956 placement stability, reduce the need for congregate care, and decrease lengths of stay in care for all youth, including those with psychological, behavioral or emotional challenges.

DCFS will address the need for community-based services by developing evidence-based supports and services included within the “SAMHSA 8” framework.10 Among other things, DCFS will substantially increase the number of youth served through Intensive Placement Stabilization

Services (“IPS”),11 which provides a mix of formal and informal supports to both the youth in care and their caregivers. IPS services include therapy, respite services, in-home family support, crisis intervention and psychosocial education as well as recreational supplies, tutoring and school advocacy. DCFS will also increase the amount of flex funds available to caseworkers and increase the number of youth for whom such funds are used. Flex funds are used to address highly individualized needs of the child and family by securing mentors and other para-professional services, respite services, transportation, and for paying fees for enrichment activities such as camps, YMCA programs, and non-traditional therapeutic-like services such as art classes.

DCFS’s second focus for resource development addresses youth with significant behavioral and mental health needs who are experiencing significant instability in their living arrangements. The Expert Panel found an association between youth experiencing four living

10 See Joint CMCS and SAMHSA Informational Bulletin, “Coverage of Behavioral Health

Services for Children, Youth, and Young Adults with Significant Mental Health Conditions,” issued by the Substance Abuse and Mental Health Services Administration (“SAMHSA”) and the Center for Medicaid and CHIP Services, May 7, 2013, available at: https://www.hhs.gov/hhs-guidance-documents/CIB-05-07-2013_222.pdf. The SAMHSA 8 are categories of services from major federal demonstration projects that, when provided in conjunction with traditional mental health services, were beneficial in maintaining children in their home communities. The SAMHSA 8 categories are: (i) intensive care coordination and wraparound approach; (ii) peer services: parent and youth support services; (iii) intensive in-home services; (iv) respite services; (v) mobile crisis and response stabilization services; (vi) flex funds (customized goods and services); (vii) trauma-informed systems and treatments; and (viii) other home and community-based services.

11 The IPS program is consistent with the intensive in-home and the mobile crisis and response stabilization categories of the SAMHSA 8.

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DCFS anticipates that if it provides intensive intervention upon identifying a youth with living arrangement instability, performs a case review, and promptly provides services identified as a result of a subsequent CFTM, the youth will have improved outcomes, greater stability, and an enhanced chance of achieving a permanent home rather than aging out to independence.

Implementation of this intensive intervention, including demonstration that youth involved in the intervention have received the recommended services and have improved living arrangement stability after the intervention, is one of the three Satisfaction Criteria for this Plan (see discussion infra at 34-37).

DCFS has set several improvement goals for the Resource Development Intervention. One is to achieve a year-over-year increase in the number of youth who receive IPS from a current baseline of 950 youth (4% of youth in care), with an initial improvement benchmark of 5%.12 It is anticipated that increasing this number will lead to improved living arrangement stability for youth and increase their likelihood of achieving permanency. Another goal is to achieve a year-over-year increase in the expenditure of flex funds from a current baseline of $1.6M. The benchmark for this measure will be refined when a refined tracking of funds is implemented, and improvement benchmarks will be developed over time in consultation with the Expert Panel.

DCFS will also be tracking the number of living arrangement moves for youth experiencing four moves in a 12-month period when one of the moves includes a psychiatric hospitalization, with the goal of reducing the current baseline rate of 9.57 moves per year for these youth to fewer than

12 The data used to set the baselines and benchmarks referenced herein is described infra at 23-26.

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4.0 living arrangement moves per year.13 The Department’s interim improvement benchmark is

5.4 living arrangement moves.

B. Quality Family Engagement

DCFS currently is not meeting the federal benchmark (95%) for monthly in-person caseworker contacts with youth. https://dcfs.illinois.gov/apsr-fy23-addendum-f.pdf. In addition, casework practice generally has been focused on meeting compliance measures rather than prioritizing quality engagement and relationship building with children and their families. The theory of change underlying the Quality Family Engagement Intervention is that caseworkers and supervisors can best assess and address the needs of youth and their families, and accelerate youth achieving permanency, through frequent and high-quality contacts with youth, their parents, and their caregivers.

One target for this Intervention is to achieve and maintain the federal benchmark requiring

95% of youth to have monthly in-person contact with their caseworker. U.S. Department of Health and Human Services, Administration for Children and Families, Program Instructions, ACFY-CB-

PI-23-01 (2023), Program Instruction for the June 30, 2023 State submission of: (1) the fourth

Annual Progress and Services Report (APSR), at 25. It is expected that this increased frequency of contacts will be important in improving youths’ safety and reducing maltreatment.

This Intervention, however, requires more than compliance with numerical benchmarks.

DCFS recognizes that quality engagement and relationship-building with youth and families are key to assessing youths’ needs, identifying the appropriate services, reducing living arrangement instability, and improving timeliness to permanency. DCFS accordingly is implementing practice-focused coaching and new systems for accountability for supervisors and caseworkers. This

13 This outcome is further described in the third Satisfaction Criteria for this Plan. See discussion infra at 35-37.

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DCFS will use Administrative Case Review (“ACR”) quality ratings to help determine the quality of caseworker engagement with families. Interviewing family members and youth through the ACR process is important to gaining an understanding of their perspective. In addition, quality case record reviews performed by the Agency Performance Monitoring and Execution (“APME”) team will be used to measure and assess changes in quality practice, with a focus on areas most essential for practice improvement. The results of these reviews will be displayed on user-friendly dashboards, which will be used to monitor improvement in the quantity and quality of caseworker contact with families. APME will also use these reviews to identify programmatic corrective actions that are needed by the private agencies and DCFS permanency teams, and to ensure corrective action is taken. DCFS is further developing its internal processes for ensuring that identified poor performance is addressed.

DCFS’s goals for this Intervention include increasing the percentage of monthly in-person quality caseworker contacts with youth that are rated as a strength in the ACR from a provisional baseline of 85%, to an initial improvement benchmark of 91%. DCFS has also set an interim goal of improving collaboration with families as reflected by an increase in the percentage of youth with case plan development and content rated as a strength in the ACR from a provisional baseline of 28%, to an initial improvement benchmark of 35%.

C. Child and Family Team Meetings

CFTMs are an essential component of the Illinois Core Practice Model that DCFS adopted as part of its reform efforts under the 2016 Implementation Plan.14 Care coordination through

14 The Illinois Core Practice Model was part of DCFS’s efforts under the 2016 Implementation to create a set of child welfare practices that put children and families at the center of service planning and to build community and home-based resources to serve children and families. Key to the

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CFTMs is designed to engage youth and family members in planning to ensure that the services, supports and living arrangements youth need are identified and provided. Although DCFS implemented the CFTM practice statewide, it has not seen significant improvements in the quality of CFTMs being conducted.15 The theory of change underlying this Intervention is that improving the practice of CFTMs supports the voice of youth and family in the care that youth receive; invites participation from supportive family, friends, and community partners; and provides families with an opportunity to identify their strengths, needs, challenges and alternative solutions in service planning and development of placement and permanency options for the youth. CFTMs also provide an opportunity to discuss the benefits of licensure for relative caregivers, the supports available to maintain the youth in a home setting rather than institutional care, and ways to ensure youth can maintain connections to positive and supportive adults.

For this Intervention DCFS is undertaking intensive coaching for supervisors within the six Meta Model Pilot Teams so that the supervisors can provide better guidance to caseworkers.

The goal is to enhance the frequency and quality of CFTMs until CFTMs meeting DCFS’s policy requirements becomes a regular casework practice within the Pilot Teams. DCFS will also evaluate integration of improved CFTM practice with the rest of the Interventions of the Meta

Model.

Illinois Core Practice Model are the use of CFTMs, along with enhanced training through the

Model of Supervisory Practice (which trained supervisors on how to coach permanency workers) and the Family Centered, Trauma Informed and Strength Based training (which established guidelines for caseworkers and supervisors for improving family engagement, assessment, and case planning). See Dkt. 531.

15 DCFS Procedure 315.105 includes five elements that are required in order for a CFTM to meet established fidelity standards: (i) preparation with the family / youth / team in advance of the meeting; (ii) an identified team of participants (minimally parent(s) / youth, caseworker, supervisor, formal and informal supports identified by parent(s) / youth); (iii) supportive and responsive to the “voice and choice” of the parent(s) / youth; (iv) develop / review case plan, progress toward permanency, and effectiveness; and (v) coordination of care among providers, implementation of case plan goals, and removal of implementation barriers.

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Initial work for the CFTM Intervention has already begun. DCFS has worked with outside consultants to provide updated CFTM training to supervisors and caseworkers in the Pilot Teams.

Regional Practice Directors (“RPDs”) are providing “at the elbow” support to supervisors, who are the primary coaches helping caseworkers with both the technical and practical application of

CFTM principles and skills. DCFS will continue to develop mechanisms to collect and track data on a timely basis to monitor the number and quality of CFTMs in the Pilot Teams. Monthly data will be gathered and shared with DCFS and private agency stakeholders, and DCFS leadership will take steps to address identified barriers to implementation.

Proper use of the CFTM strategy will be reinforced through the ACR case reviews conducted every six months for each youth in care. ACR reviewers are receiving coaching on

CFTM practice so they can appropriately assess CFTM performance as part of the ACR quality scoring process. ACR review data further will be used to create a monitoring tool specific to

CFTMs through which feedback will be given to DCFS and private agency caseworkers.

As discussed above, DCFS is testing this intensive approach to improvement of CFTMs as part of the Meta Model pilot to determine how to achieve improved use of CFTMs by caseworkers statewide. Implementation, testing and evaluation of this Intervention in the six Pilot Teams, alongside the rest of the Meta Model Interventions, will then inform any refinements of DCFS’s approach to CFTMs and help DCFS identify when, under the principles of implementation science, the CFTM Intervention may be ready for statewide rollout. See discussion supra at 12-15.

DCFS’s interim output goal for this Intervention include increasing the percentage of youth in the six Pilot Teams with a CFTM that meets DCFS policy fidelity standards (see n.14 supra) from a current provisional baseline of 26% to above 50%. DCFS has a parallel interim outcome goal of increasing the percentage of youth in the Pilot Teams with a CFTM quality rating score of

‘1’ (which is full implementation / outstanding performance), or ‘2’, (which is substantial

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 16 of 54 PageID #:7962 implementation / good performance), within the applicable six month period of review.16 DCFS’s initial benchmark for improvement is 50% from a provisional baseline of 31%. These two “greater than 50%” benchmarks are appropriate because DCFS’s purpose here is to identify when this

Intervention leads to “successful” implementation of CFTM practice in the Pilot Teams.

Implementation science acknowledges that fidelity standards seldom reach 100% due to staff attrition, vacancies, training requirements, and other external factors over which programs exercise limited control, such as client compliance with treatment plans. Therefore, “above 50%” is a threshold fidelity standard for measuring “success” in implementation – whether a complex innovation has been implemented as intended and is ready for expansion to statewide use.17

D. Home of Relative / Fictive Kin Licensure

The number of children in kinship homes rose from 7,232 as of June 30, 2018 to 11,186 as of June 30, 2022.18 Currently, the majority of youth coming into care are placed with relatives or fictive kin. Licensing efforts by DCFS and its private agencies have struggled to keep up with the increased use of relative homes for placement. As the rate of placement in relative homes has increased, there has been a decline over the last four years in the percentage of relative homes that

16 A CFTM is rated ‘1’ if all elements of the CFTM were evident and the CFTMs occurred at least quarterly. A CFTM is rated ‘2’ if either (a) a CFTM occurred and all elements were evident to the reviewer, except there was no evidence of a prep meeting with the parents / youth before the

CFTM; or (b) a CFTM occurred and all elements were present (or all elements except the preparation meeting) but CFTMs occurred less than quarterly during the applicable six month period.

17 This assessment of the fidelity of CFTM implementation in the Pilot Teams enables DCFS to know that its innovations are being implemented as intended, attribute outcomes to the use of the innovations, and what to focus on to improve implementation. Integrating evidence-based practices into the delivery of child welfare services that meet a threshold fidelity standard of above

50% is a complex process that involves the selection of appropriate practices, the development of an enabling environment to support high-quality implementation of the practices, and systems changes that will ensure the practices are sustainable beyond the first 18 to 24 months of implementation. https://www.acf.hhs.gov/cb/guide_vol3.pdf.

18 Dkt. 801 at 12.

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The focus for this Intervention is to achieve a substantial increase in the percentage of relative caregivers’ homes that are licensed. The theory of change is that by becoming licensed, relative and fictive kin caregivers will receive additional monetary and other supports, which will lead to improved safety and stability of children in relative foster care. Further, licensure opens up the permanency option of subsidized guardianship through the federal KinGAP program.

DCFS’s implementation strategies to improve the rate of licensure for relative caregivers include clarifying the roles of all DCFS and private agency staff in the licensing process for relative caregivers, ensuring that such staff understand their role in that process, and ensuring that discussions about licensure take place at the initial placement of a youth and continue through the lifetime of a case. A licensing worker will be assigned to the relative caregiver and will maintain contact with the relative caregiver in order to assist with the licensure process.

DCFS also will increase monitoring and communication activities with private agency and

DCFS staff in order to bring attention to this work. DCFS will support private agency and DCFS staff with ongoing consultation from APME staff. DCFS has taken steps to increase the number of private agency staff, including staff to conduct licensing work, and increased the pay for private agency workers with additional increases planned for future years. DCFS continues to examine licensing staff ratios and pay disparities in the private sector to evaluate whether additional efforts are needed. DCFS will be encouraging caseworkers to address individualized circumstances that

19 DCFS budget overviews show that the number of children placed with kin expanded from 7,640 as of June 30, 2018 to 11,538 as of June 30, 2022. During this period, the number of licensed homes declined from 52.1% to 37.6% as reported in the Department’s Licensure Progress Reports for FY2020-2023. https://dcfs.illinois.gov/fy22_budget_proposal_overview.1.0.pdf, and budget-proposal-overview-fy2024.pdf (illinois.gov).

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 18 of 54 PageID #:7964 https://dcfs.illinois.gov/content/dam/soi/en/web/dcfs/documents/about-us/reports-and-statistics/documents/fy22_budget_proposal_overview.1.0.pdf https://dcfs.illinois.gov/content/dam/soi/en/web/dcfs/documents/about-us/documents/budget-proposal-overview-fy2024.pdf https://dcfs.illinois.gov/content/dam/soi/en/web/dcfs/documents/about-us/documents/budget-proposal-overview-fy2024.pdf some relative caregivers face in becoming licensed by using flex funds to secure appropriate services and supports.

DCFS’s improvement goals for this Intervention include increasing the number and percentage of licensing applications completed within 120 days of placement of a youth in the home from a baseline of 565 (18%) to an interim improvement benchmark of 685 (25%). DCFS will also be working to increase the number of relative homes licensed within 270 days of placement of a youth in the home from a baseline of 523 (17%) to an initial improvement benchmark of 660 (23%).20

E. Residential Monitoring

The theory of change underlying this Intervention is that enhanced monitoring of residential treatment facilities by DCFS and its contracted external providers will improve safety for youth in those facilities and result in faster and more appropriate discharges to home and community settings.

DCFS’s enhanced model for residential monitoring is a structured process. Monitors will collect information about the quality and safety of services delivered within each residential facility as required by their contracts with DCFS. Monitors will also summarize the information they have gathered, and will share that information and their assessments with residential facilities.

Based on the information gathered, facilities will be referred for intervention to address deficiencies, when appropriate, and for follow up as required.

Monitoring activities will include review of performance data for the facility, on-site observations at the facility, periodic attendance at facility staffings and meetings, and review of facilities’ files. A new data collection tool and review instrument is a critical component of the

20 For this Intervention, DCFS has identified cohorts of youth and will measure the rate and / or increase in licensure by each of these cohorts.

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 19 of 54 PageID #:7965 enhanced model and is being developed in collaboration with the Expert Panel and university partners. It will be thoroughly vetted and tested prior to implementation. The new tool will focus on the following areas:

(i) the living environment at the facility;

(ii) the youth’s experience at the facility;

(iii) the youth-guided and family-driven treatment at the facility;

(iv) the staff training and education at the facility;

(v) the milieu operations at the facility;

(vi) the clinical programs and program leadership at the facility;

(vii) the management of the facility; and

(viii) the quality improvement processes at the facility.

DCFS is also adopting Residential Performance Measures (“RPMs”) based on administrative data.

Quarterly RPM data reports and data from the new monitoring tool will be used to complete written quarterly assessments identifying the strengths and needs of the facilities and any necessary corrective action.

The enhanced residential monitoring model also includes a change in role for the existing external partners who are still working under the monitoring design from the 2016 Implementation

Plan. The external partners currently serve as frontline monitors for a set of residential facilities.

During the development stage of the enhanced model, the external partners will continue in that direct monitoring role while also providing consultation to DCFS. As the enhanced model is implemented, the external partners’ responsibilities will gradually shift. Under the new model they will provide targeted programmatic consultation, at DCFS’s request, to residential facilities to remediate identified deficiencies; conduct random unannounced inspections at selected residential facilities under contract with DCFS each year; and perform inspections at residential facilities when certain agreed-upon indicators are met. During the random inspections, the external partners will use DCFS’s new data collection tool and instrument to summarize aspects of quality

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 20 of 54 PageID #:7966 and safety, recommend corrective measures where specific performance standards are not met, and provide any additional feedback regarding the performance of the facility not captured by the tool.

DCFS’s key output goal for this Intervention is to produce written Quarterly Assessments based on results of the new monitoring tool, RPM quarterly reports, and summaries identifying strengths and weaknesses to guide corrective action. In addition, DCFS’s outcome goal is to increase the percentage of residential treatment facilities with improved scores in the performance areas identified above. Because DCFS has not yet implemented the new monitoring tool, DCFS does not have baseline data for this key output and outcome. Baselines and improvement benchmarks for this Intervention will be set in consultation with the Expert Panel when sufficient data is available.

F. Subsidized Guardianship

Subsidized guardianship is a safe and stable permanency option, but it has been underused in Illinois for the last several years. The underutilization of subsidized guardianship is significant in light of DCFS’s performance in achieving permanency for youth in care for two years or more.

When relative caregivers and youth prefer guardianship (a route that does not require termination of parental rights), honoring their choice leads to more children achieving permanency and fewer suffering the negative outcome of aging out of foster care without a permanent place to call home.

The theory of change for this Intervention is that by increasing the use of subsidized guardianship, DCFS can increase the number of youth who achieve permanency and make substantial, system-wide progress in reducing youths’ length of stay in care.

DCFS already has completed important foundational work to set the stage for increasing the use of subsidized guardianship, including offering state-funded guardianship to youth in care aged 12 and older regardless of the licensing status of the foster placement, expanding the legal definition of ‘relative’ to include fictive kin, and eliminating the statutory requirement that

Case: 1:88-cv-05599 Document #: 834-1 Filed: 10/24/23 Page 21 of 54 PageID #:7967 adoption be ruled out prior to courts’ considering subsidized guardianship as a permanency goal.21

DCFS also has developed a targeted system to identify and track youth in care who may be eligible for subsidized guardianship.

The Subsidized Guardianship Intervention addresses the next steps DCFS will be taking to increase the number of youth in care who achieve permanency through subsidized guardianship.

The new DCFS strategies will include: (i) communicating the benefits of subsidized guardianship to stakeholders involved in Juvenile Court cases, including that children placed in subsidized guardianship homes remain as stable as youth who are adopted or remain in foster care; (ii) informing relatives of the financial benefits of licensing and their eligibility for a subsidy when they choose guardianship; and (iii) increasing the use of DCFS discretion to waive non-safety licensure standards. DCFS will also identify DCFS teams and private agencies that are successfully moving youth to subsidized guardianship in a timely manner. The strategies used by those agencies will be identified and shared with agencies that have a low success rate in moving youth to subsidized guardianship.

DCFS’s initial output goal for this Intervention is to identify and track the number of youth in care that meet the criteria for the guardianship permanency goal, and initially to maintain the percentage with an assigned guardianship permanency goal at 5% (the baseline number is 1,434).

DCFS further has set an interim outcome goal of increasing the number of youth in care discharged to permanency through subsidized guardianship in a one-year period from a baseline of 402 youth to 480.

21 See Public Act 98-846 (adding ‘fictive kin’ to the definition of ‘related’) (eff. Jan. 1, 2015);

Public Act 99-0836 (expanding definition of fictive kin) (eff. Jan. 1, 2017); see also Public Act

102-0193 (eff. July 30, 2021) (eliminating requirement that adoption be ruled out as permanency option prior to consideration of guardianship); and Ill. Admin. Code tit. 89, §302.410 (criteria for state funded guardianship).

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G. Administrative Case Review

The ACR Unit reviews each youth in care’s case every six months. In the past, the ACR process has focused on compliance with a youth’s most recent service plan, rather than ongoing evaluation of permanency planning. In addition, key stakeholders (including youth and their families) were not participating in ACRs, the feedback process focused on case specific issues, and the feedback process did not yield data on casework practice strengths at a team or agency level. The theory of change for this Intervention is that providing actionable feedback broadly within DCFS and to private agencies (including caseworkers and supervisors) will lead to improved quality casework, increased family participation at ACRs, timely reunification where possible, assistance to kinship caregivers in adapting to DCFS policies, and expedited permanency for youth.

DCFS has created a new ACR model that focuses on quality of work in five priority areas that correlate with increases in youth achieving permanency:

(i) Quality of Child and Family Team Meetings;

(ii) Quality of Case Planning (whether the caregiver / child actually received the services / supports the plan that the team determined they needed in order to move toward permanency);22

(iii) Quality of Caseworker In-Person Visits (with children in care, children at home, mother, father and foster parent or facility staff);

(iv) Quality of Family Visitation (siblings, mother, father, and other important connections); and

(v) Quality of Caseworker Supervision.

22 DCFS is in the process of replacing its current case management system, the Statewide

Automated Child Welfare Information System, where youth “Service Plans” are currently entered.

Once the new system is established, DCFS will switch to the use of “Case Plans”, which will capture more information that can be used during the ACR process.

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The new ACR model was launched statewide in September 2022.23 A revised case review information packet is organized around these five priority areas. A key feature of the new ACR model is the active participation and discussion with all attendees at the ACR, including solicitation of stakeholders’ experience and perspective of how the case has progressed since the last ACR. ACR reviewers have been trained and coached on how to solicit relevant information and rate each priority area. The written feedback from the ACR reviewer to the supervisor and caseworker has also been enhanced to provide substantive information learned about the caseworker’s performance in priority areas, and the caseworker’s assigned supervisor is required to ensure that identified areas needing improvement are addressed.

Data collected…