October 2023 Integration Reportt_10.23.2023_Dkt 833.pdf

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

OCTOBER 2023 INTEGRATION REPORT

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Table of Contents

I. The Significance of Piloting the Meta Model

II. Validation of the Pilot Teams and Comparison Teams

III. The Status of Meta Model Integration in the Pilot Teams

IV. Initial Data for the Pilot and Comparison Teams

A. The Resource Development Intervention

i. Expanded Use of IPS Services

ii. Expanded Use of Flex Funds

iii. Status of Integration

B. The Quality Family Engagement Intervention

i. Improved In-Person Quality Caseworker Contacts with Youth

ii. Improved Collaboration with Families in Case Planning

iii. Status of Integration

C. The Child and Family Team Meetings Intervention

i. Improved Adherence to CFTM Fidelity Standards

ii. Improved CFTM Quality

iii. Status of Integration

D. The Home of Relative/Fictive Kin Licensure Intervention

i. Licensing Applications Submitted within 120 Days of Placement

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ii. HMR/HFK Licenses Approved Within 270 Days of Placement

iii. Status of Integration

E. The Subsidized Guardianship Intervention

i. Increased Assigned Guardianship Permanency Goal

ii. Improve Number of Youth Discharged Through Subsidized Guardianship

iii. Status of Integration

F. The Administrative Case Review Intervention

i. Increased Attendance and Participation in the ACR

ii. Improved ACR Ratings in Five Priority Areas

iii. Status of Integration

G. Performance on the SIP Satisfaction Criteria

i. Improved Permanency in 12 months for youth in care for 24 months

ii. Reduced maltreatment among youth in care per 100,000 care days

iii. Reduced living arrangement moves for YNI Youth

H. Expert Panel’s Observations

Conclusion

Appendix A

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This Integration Report is submitted jointly by the Parties in connection with the

Superseding B.H. Implementation Plan (SIP, Dkt. 816), which was adopted to address certain requirements of the B.H. Consent Decree. Dkt. 456. This Report covers data from the reporting period of January 1, 2023, to June 30, 2023, and addresses DCFS’s efforts to implement and test the impact of the seven SIP Interventions in six Pilot Teams.1

This first Integration Report focuses primarily on the foundational steps DCFS has taken to build an enabling environment in the Pilot Teams that will support integration of the

Interventions. This includes establishing the Pilot Teams and Comparison Teams that will allow for ongoing assessment of the impact of DCFS’s implementation. The Department’s foundational work impacts all of the Interventions and is essential for successful implementation of the Meta

Model and accurate reporting on the success of the Interventions. Below DCFS provides: (i) a brief overview of the SIP requirement to pre-test the Meta Model reforms using Pilot Teams; (ii) an update on the validation of the Pilot Team / Comparison Team testing process; (iii) the status of Meta Model integration efforts in the Pilot Teams; and (iv) initial data for performance metrics in the Pilot Teams as compared to data for a statistically equivalent set of Comparison Teams.

I. The Significance of Piloting the Meta Model

The SIP was developed in response to significant changes in the landscape of child welfare in Illinois over the last several years. Illinois now institutionalizes far fewer children than was customary in the past, which is positive. In addition, Illinois’s reliance on relative and fictive kin caregivers has expanded substantially, such that far more youth – approximately 60% – living in

1 Pursuant to the SIP, the parties and Expert Panel are to file an “Integration Report” once every six months. Dkt. 816 at 33-34. Integration Reports are based on data available as of the close of the latest six-month review period preceding the Report due date. Id.

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In response to these changes, DCFS must further develop its network of essential community-based supports to help maintain youth where they belong – in the most appropriate and home-like setting – and to meet the needs of youth living with kin caregivers and ensure those caregivers receive the support they need. The seven Interventions outlined in the SIP, as integrated under the Meta Model, are meant to address the needs of children living with relatives and fictive kin, improve care provided to youth with significant mental and behavioral health needs and to develop community-based resources for all children in care. The seven Interventions are intended to work together in a synergistic fashion such that each builds upon the others, as depicted in the

Meta Model diagram below:

(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.

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The SIP requires DCFS to test the impact of the Meta Model by implementing all of the

SIP Interventions simultaneously in a set of select Pilot Teams and then using performance data to assess whether desired improvements in serving youth have occurred. This testing process will enable DCFS to determine the overall effectiveness of the Interventions and Meta Model, modify them as needed, and develop an effective strategy for statewide rollout and integration of

Interventions that prove to be successful. The testing process is a critical element of the

“experimentalist approach”2 that DCFS adopted under the SIP, and it is fully endorsed by the

Expert Panel. As discussed below, DCFS has spent significant time in the last several months ensuring that the testing process is sound and will generate reliable data regarding the SIP reforms.

II. Validation of the Pilot Teams and Comparison Teams

When the SIP was filed, DCFS already had identified the six Pilot Teams in which full integration of all seven SIP Interventions is to occur, and six Comparison Teams that (unlike the

Pilot Teams) are not receiving the same supported and resourced implementation of the Meta

Model. Dkt. 816 at 6, fn. 7. Both sets of Teams were identified with the Expert Panel’s assistance.

Each Pilot Team and each Comparison Team consists of one supervisor and approximately five caseworkers, and each serves approximately 70 – 90 youth at any given time.3

Under the experimentalist approach, it is essential for the Pilot Teams and Comparison

Teams to be “statistically equivalent.” Without that any differences between the results achieved by Pilot Teams and the Comparison Teams cannot reliably be attributed to the impact and

2 The “experimentalist approach” to change management is described more fully in the SIP. Dkt.

816 at 2-3.

3 Both sets of Teams include two DCFS permanency teams and four private provider permanency teams. Dkt. 816 at 6, n 7. The division between DCFS and private provider teams in the Pilot and

Comparison teams were designed to mirror the statewide split between DCFS and private provider permanency teams.

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Comparison Teams has required significant analysis, and the process has been complicated by the fact that the youth served by the two sets of Teams will change over time.

When the SIP was submitted for the Court’s approval, DCFS had only begun the validation process, and had concluded that the Teams were sufficiently comparable in respect to basic demographics of youth served. DCFS continues to work closely with the Expert Panel and various university partners in the ongoing process of validating the comparability of the Pilot and

Comparison Teams. The Department now can confirm that between the baseline period for the

Pilot Team metrics4 and the current reporting period of January 1, 2023 to June 30, 2023, there has been only a slight change in the demographics of the Pilot and Comparison Teams, as shown below:

4 Based on the advice of the Expert Panel, in future Integration Reports DCFS will use full-year data for baseline and reporting periods. This change will help to minimize the amount of seasonal and other types of variability and assist in making the reporting period data easier to compare to subsequent reporting periods. For this Integration Report, “provisional” reporting and baseline data is provided. The reporting data period is January 1, 2023 to June 30, 2023, as that provides the most accurate available data now accessible. The provisional baseline period for the Pilot

Team metrics is the six-month period, July 2022 to December 2022, except for the Maltreatment in Care measure, which is July 1, 2021 - June 30, 2022. The maltreatment in care measure is treated differently because of the previously recognized seasonality and rarity of maltreatment events.

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JULY 2022 - DECEMBER 2022 JANUARY 2023 - JUNE 2023

(BASELINE PERIOD) (CURRENT REPORTING PERIOD)

The few changes that occurred, i.e., racial composition of the two groups, were anticipated as youth exited and entered the care of the Pilot and Comparison Teams at different rates.5 Significantly, however, the characteristics of the target populations in both sites remain statistically equivalent with respect to gender, race, and age at provisional baseline.

By contrast, during the first six months of the Pilot the data show statistically significant differences in average duration of spells and percentage of Black youth between the Pilot and

Comparison Teams. The Parties and the Expert Panel will monitor these differences and employ statistical controls, if necessary, to accommodate possible changes in the composition of the Teams for testing purposes. That work will include analysis of the case flow dynamics of entries into and exits from the sites, and DCFS anticipates reporting on the results of this analysis in the next

Integration Report.

5 These chance differences may lessen as more children exit and enter the Pilot and Comparison

Teams.

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In addition to the above, the validation process for the Pilot and Comparison Teams has been expanded to encompass rate of maltreatment in care and rate of permanencies. See Appendix

A. Like the general characteristics of the target populations, the rates of maltreatment in care and permanence for both sets of Teams are statistically equivalent within the bounds of chance differences.

With the assistance of the Expert Panel and university partners, DCFS will continue to monitor the integrity of intervention efforts and the comparability of the Pilot and Comparison

Teams and the youth they serve to ensure that, as integration of the Meta Model Interventions proceeds in the Pilot Sites, any differences in performance between the two sets of teams can be attributed to reforms implemented under the Meta Model. It will be especially important to monitor the movement of cases out of Pilot Teams and minimize “cross-overs” from Comparison to Pilot teams. During the provisional baseline period, DCFS observed higher than desired movement of cases from their assigned Pilot Teams to teams not engaged in integration efforts.

According to the Expert Panel and as explained below, attrition requires special monitoring as reform efforts move forward in order to ensure the validity of the findings.

III. The Status of Meta Model Integration in the Pilot Teams

Reliable measurement of the impact of Meta Model integration in the Pilot Teams depends on full integration being achieved. That will occur when every caseworker in the Pilot Teams can regularly and appropriately answer all of the following questions that are at the heart of the seven

SIP Interventions:

Safety: “Who is living in an unlicensed home and what do we do next to get them licensed?”

Permanency: “Who has a goal of guardianship that hasn’t been achieved yet?

What’s the next step to move this goal along?”

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Well-Being: “How can I use flex funds to get needed services for our youth?”

Least Restrictive Care: “Which youth are remaining in more restrictive living arrangements (e.g., Qualified Residential Treatment Programs, psychiatric hospitals)? How do I move them to more family-like settings, strengthen their connection to significant adults, and provide services and supports they need to develop and thrive?”

Integrated Assessment: “How will I identify youth needs and overcome case-specific obstacles to ensure youth and families I work with receive the services they need?”

Systemic Reform: “How will I identify systemic barriers to youths’ needs being met and communicate them up the DCFS chain to ensure they are appropriately acted upon to access, develop, and implement needed services and supports, particularly for youth with serious behavioral health needs?”

Engagement: “Am I engaging youth and families to ensure that youth and families’ voices, preferences and choices are meaningfully incorporated into plans and services through active CFTM and ACR participation and used to meaningfully impact progress toward permanency, youth well-being, and reductions in youth moves and incidents of maltreatment while in care?”

Reaching the goals of integration in the Pilot Teams will require extraordinary effort. The size and complexity of DCFS and its operations will make change difficult enough, and additional complications will flow from the fact that independent private agency providers under contract with the Department perform most of the front-line work with youth in care.

The principles of Implementation Science emphasize that creating and sustaining institutional change require commitment by leadership. That commitment must be shown by funding development of needed resources, clearing away administrative and structural barriers impeding change, and creating an “enabling environment” for workers that supports, rather than discourages, the small-scale testing of new ideas and strategies even when some of the tested ideas

Case: 1:88-cv-05599 Document #: 833 Filed: 10/23/23 Page 10 of 30 PageID #:7913 do not pan out.6 In the Pilot Teams, DCFS has begun to identify barriers as initial steps toward integration are underway, including:

• Staff attrition and vacant positions are key issues that impact both

DCFS and private agency providers and result in excessive caseloads.

The Expert Panel recommends that DCFS identify and implement new ways to accommodate and respond to this issue. Resolution cannot be delayed in anticipation of increased hiring and improved caseworker headcount.

• Excess attrition of child and family cases from assigned Pilot Teams threatens the validity of the evaluation of the experimental interventions.

Attrition from the Pilot Teams can result in “cases being transferred from caseworkers who had participated in the training and consultation to caseworkers who had not,” as well as “supervisors who were working with caseworkers to implement the practice principles and method being replaced by supervisors who were unfamiliar with these practice principles and methods.”7

• The Department’s process for licensing relatives and fictive kin is burdensome, and those who do not complete the process are deprived of beneficial financial support.

The recent issuance of federal regulations, which permits the use of less burdensome approval standards for qualifying relative and fictive kin for federal child welfare benefits, should

6 Implementation Science is described more fully in the SIP. Dkt. 816 at 2-3.

7 Drawing from previous experience in evaluating other DCFS initiatives, Dr. Gleeson, associate professor emeritus at the University of Illinois-Chicago, also notes: “Other barriers included multiple tasks caseworkers and supervisors were attempting to complete to comply with policy and procedural requirements. With the pressure of these multiple demands, caseworkers were unlikely to implement the ’new’ practice principles and methods unless closely monitored, supported, and encouraged by their supervisor. These principles and methods were clearly different from current practice, and with competing demands, even the most knowledgeable and committed supervisors were unlikely to encourage and reinforce implementation of the practice principles and methods unless they too were consistently encouraged to do so.” James P. Gleeson, Reflections on Kinship Care 68 (Mark F.

Testa PhD., et al. eds., 2020).

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• Permanency plans for subsidized guardianship are not resulting in permanencies for youth in care at the rate they should.

DCFS has three times as many youth with a permanency goal of guardianship as guardianships are actually achieved.

Due to the foregoing barriers, the Expert Panel has advised that substantially more on-the-ground work must be done before real progress can be made toward implementation of the Meta

Model in the Pilot Teams. DCFS concurs, but also recognizes that it does not currently have in place internal support structures needed to assist the Pilot Teams in developing creative, small-scale solutions for removing implementation barriers. DCFS is addressing this issue by again partnering with implementation science experts from the Collaborative for Implementation

Practice at the University of North Carolina (UNC) at Chapel Hill School of Social Work, which is headed by Dr. Allison Metz.

The UNC team will be helping DCFS’s Pilot Teams to implement the Meta Model for reform as described in the SIP. UNC will begin by working with the Pilot Teams to strengthen role clarity and communication related to implementation of the seven interventions and their integration. Through engagement with the Pilot Teams, UNC will reinforce that maintaining a focus on implementation quality must become an everyday practice within those Teams. UNC will help DCFS identify implementation barriers in the Pilot Teams, craft solutions to those

Case: 1:88-cv-05599 Document #: 833 Filed: 10/23/23 Page 12 of 30 PageID #:7915 barriers, develop implementation strategies, and set goals and timelines for achieving the requirements of the SIP. UNC’s work with the Pilot Teams will inform DCFS’s development of the statewide adoption of the experimentalist approach as a routine component of its operations.

DCFS anticipates that UNC will begin working with the Department by the end of the year.

In anticipation of the UNC collaboration, DCFS is already laying the groundwork for the

Meta Model’s implementation in the Pilot Teams. DCFS made a presentation about the Meta

Model on September 5, 2023, for Pilot Team Program Managers and supervisors to review all seven Interventions in the SIP. This presentation included specific information on each of the key

Outcome and Output measures for each Intervention, along with the specific benchmarks that

DCFS anticipates meeting. The purpose of this presentation was to better inform the Pilot Teams on all interventions and to familiarize them with all Outcomes and Outputs in the SIP. Chapin Hall has conducted a focus group with supervisors involved in the Pilot Teams and will be holding focus groups on an on-going basis. And DCFS is developing a “Field Guide” containing active links to resources items such as an IPS referral directory, Motivational Interviewing guide, and relative caregiver brochure.

DCFS is also expanding the team of staff reporting to the B.H. Executive Administrator to better monitor and oversee integration of the Meta Model in the Pilot Teams. This expansion, which will include new positions, will consist of individuals who will be directly accountable for reviewing data from the Pilot Teams to identify trends and evaluate progress. These individuals will work directly with the Pilot Teams, will be empowered to identify barriers being experienced in the Pilot Teams, and will coordinate DCFS staff to create solutions. The goal of this expansion is to ensure integration of the Meta Model occurs with fidelity through regular and direct involvement with the Pilot Teams for the simultaneous implementation of all seven

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Interventions. DCFS is prioritizing finalization of this support structure and filling the positions it requires.

IV. Initial Data for the Pilot and Comparison Teams

DCFS worked closely with Chapin Hall to develop data systems for measuring the outcomes and outputs for the Integrated Meta Model in the Pilot and Comparison Teams. With this data, it will be possible to track:

• Progress of the Pilot Teams relative to their baseline performance;

• Progress of the Pilot Teams towards the Interventions’ Benchmark targets; and

• Differences in performance between the Pilot and Comparison Teams.8

Because integration is just beginning, DCFS does not yet have sufficient data for the Pilot and Comparison Teams to begin tracking any performance trends relative to their own baseline performance or relative to each other. Thus, for this first Integration Report, DCFS is providing provisional baseline data for the Pilot and Comparison Teams (reflecting the Teams’ performance before any initial Meta Model integration in the Pilot Teams began)9 and data for the current reporting period of January 1, 2023 to June 30, 2023. The presentation of data in the Integration

Report due in April 2024 will be more robust than the presentation here. It will include tables showing the Pilot and Comparison Team performance from the baseline forward, expanded baseline and reporting data periods (see n. 4, supra), and updates about steps taken in the Pilot

Teams to implement each of the Interventions.

8 Mark Friedman, Trying Hard is Not Good Enough, 88-92, Deanna Zachary, 10th Anniversary

Edition, 2015.

9 As noted above, the provisional baseline period for the Pilot Team metrics is July 1, 2022 to

December 31, 2022 unless otherwise indicated in reference to a specific metric. See n. 4, supra.

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A. The Resource Development Intervention

DCFS recognizes its obligation to serve youth in the least restrictive setting appropriate for their needs. The Resource Development Intervention reflects DCFS’s commitment to developing a robust network of community-based services intended to help maintain the stability of youth living in foster homes, and to reduce the frequency and duration of youths’ placement in more restrictive settings such as residential facilities and psychiatric hospitals.

i. Expanded Use of IPS Services

The first metric under Resource Development addresses the number and percentage of youth in care who receive Intensive Placement Stabilization (IPS) services. 10 Over time, if integration is effective, the data should reflect that more and a higher percentage of youth in the

Pilot Teams are receiving IPS services, particularly those with emotional and behavior needs and those in kinship homes.

The provisional baseline for youth receiving IPS was 4.1% (21 youth) in the Pilot Teams.

In the Comparison Teams, the provisional baseline was 2.17% (9 youth). For the reporting period, in the Pilot Teams 1.58% (9 youth) received IPS services, as compared to 1.69% (7 youth) in the

Comparison Teams. The minor changes in the first reporting period and relative stability of the performance on this measure is to be expected at this early stage.

10 IPS services provide formal and informal supports to youth and/or caregivers and can include therapy, respite services crisis intervention and psychosocial education. Dkt. 816 at 9.

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ii. Expanded Use of Flex Funds

The next metric under the Resource Development Intervention addresses year-over-year expenditures of flex funds for youth. 11 These funds provide a means for reducing living arrangement moves, thereby improving youths’ chances of achieving permanency.

DCFS cannot track the number and percentage of youth who receive flex funds statewide using pre-existing data systems. As of March 2023, however, DCFS can track this data for youth in the Pilot Teams. DCFS will use available data (March 2023 to December 31, 2023) to set a provisional baseline for this metric, will report that figure in the next Integration Report, and then will develop an initial improvement benchmark. In addition, DCFS will track and report on what flex funds have been used to purchase, the goals the flex funds are supporting (placement stability, guardianship, adoption, reunification, and/or independence), and the amount spent.

iii. Status of Integration

At this time, the Department has not yet implemented strategies for increased use of IPS and flex funds for youth in the Pilot Teams beyond the statewide strategies discussed in the October

2023 Progress Report. Dkt. 832 at 7 to 11. The Department anticipates reporting on Pilot Team-specific strategies in the next Integration Report.

B. The Quality Family Engagement Intervention

The Quality Family Engagement Intervention emphasizes the importance of meaningful caseworker contact with youth, their family members, and their caregivers. DCFS’s casework

11 Flex funds can be used to address highly individualized needs of the child by securing mentors, para-professional services, respite services, and non-traditional therapeutic-like services such as art classes. Dkt. 816 at 9.

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i. Improved In-Person Quality Caseworker Contacts with Youth

The key output for the Family Engagement Intervention is to improve the percentage of monthly in-person quality contacts between youth and their caseworker that are rated as a

“Strength.”12 The Pilot Teams’ provisional baseline was 71.84%. The Comparison Teams’ provisional baseline was 77.57%. The improvement benchmark DCFS is attempting to meet for the Pilot Teams is 91%. Because of data lag unique to this first Integration Report, DCFS is only able to examine partial data (April 1, 2023 to June 30, 2023) from this reporting period.

ii. Improved Collaboration with Families in Case Planning

The second metric for the Quality Family Engagement Intervention addresses the percentage of youth in the Pilot Teams for whom there was an ACR that rated “Case Plan

Development and Content” as a “Strength.” For the Pilot Teams, 31% of youth had an ACR with

Case Plan Development and Content Rated as a Strength during the provisional baseline period.

The provisional baseline percentage in the Comparison Teams was 27.4%. DCFS does not yet have data for the current reporting period. The initial improvement benchmark DCFS hopes to achieve in the Pilot Teams is 35%.

At this time, the Department has not yet implemented integration strategies for improved

Family Engagement in the Pilot Teams beyond the statewide strategies discussed in the October

12 ACRs – an independent process that reviews a youth in care’s case to ensure legal compliance and appropriate planning and quality performance –are conducted every six months for every youth in care. The ACR rating system is explained in greater detail in the SIP. Dkt. 816 at 21-22.

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2023 Progress Report. Dkt. 832 at 13. The Department anticipates reporting on Pilot Team-specific strategies in the next Integration Report.

C. The Child and Family Team Meetings Intervention

The Child and Family Team Meetings (CFTMs) Intervention, like the Quality Family

Engagement Intervention, focuses on improvement in caseworkers’ adherence to the Department’s core practice model. Caseworkers are expected to conduct a CFTM with each youth at least quarterly. Caseworkers currently are not conducting CFTMs with the proper frequency, and many meetings reported as CFTMs do not meet DCFS’s practice standard.13 DCFS believes that when conducting CFTMs properly becomes regular practice, there will be accelerated permanency for these youth and improvement in their safety and well-being while in DCFS care.

i. Improved Adherence to CFTM Fidelity Standards

The first metric under the CFTM Intervention addresses the percentage of youth in care in the Pilot Teams who have a CFTM that meets DCFS policy and fidelity standards. The percentage should rise as integration of the Meta Model is pursued in the Pilot Teams.

In the Pilot Teams, the provisional baseline performance was 26% of youth for the period from July 2022 to December 2022. The provisional baseline rate was 19.50% for youth in the

Comparison Teams. For this reporting period, 12.44% of youth in Pilot Teams had a qualifying

CFTM, while 18.18% of youth in the Comparison Teams had a qualifying CFTM. The improvement benchmark for the Pilot Teams is to increase to above 50%.

13 The elements for a properly conducted CFTM consistent with DCFS’s fidelity standards are set forth in the SIP. Dkt. 816 at 13, n. 14.

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ii. Improved CFTM Quality

The second metric for the CFTM Intervention addresses the quality of CFTMs. The quality measure DCFS uses is from the ACR review process, and the focus is to increase the percentage of CFTMs rated as a 1 or a 2 (the two highest ratings).14

In the Pilot Teams, 31.20% of CFTMs had a quality rating of 1 or 2 during the provisional baseline period. In the Comparison Teams, the provisional baseline percentage was 25.70%. For this reporting period, 46.89% of youth in Pilot Teams had a CFTM quality rating score of 1 or 2, while 42.43% of youth in the Comparison Teams had a CFTM quality rating score of 1 or 2.

DCFS’s improvement benchmark for the Pilot Teams is to achieve 50%.

iii. Status of Integration

At this time, the Department has not yet implemented integration strategies for improved

CFTMs in the Pilot Teams beyond the statewide strategies discussed in the October 2023 Progress

Report. Dkt. 832 at 16. The Department anticipates reporting on Pilot Team-specific strategies in the next Integration Report.

D. The Home of Relative/Fictive Kin Licensure Intervention

The SIP Interventions emphasize the need to better serve youth living in kinship foster homes and to move youth in care to permanency more expeditiously. When a relative or fictive kin caregiver is licensed, the caregiver receives additional resources to support the child. In addition, youth in their care are able to achieve permanency in that home through subsidized guardianship. The HMR/Fictive Kin Licensure Intervention is intended to result in a substantial

14 Achieving that rating requires demonstration that all of the elements of the CFTM were evident and the CFTM was conducted at least quarterly (a rating of 1) or all the elements of a CFTM were evident except there was either no evidence of a preparatory meeting or the CFTM occurred less than quarterly (a rating of 2). Dkt. 816 at 14-15, fn. 15.

Case: 1:88-cv-05599 Document #: 833 Filed: 10/23/23 Page 19 of 30 PageID #:7922 increase in the number and percentage of relative and fictive kin caregivers who become licensed and to complete the licensing process more quickly.

i. Licensing Applications Submitted within 120 Days of Placement

The key output for this Intervention addresses the number and percentage of relative and fictive kin licensing applications that were completed and recorded by DCFS within 120 days after a youth is placed in the caregiver’s home. Dkt. 816 at 24. During the provisional baseline period, the rate of homes that applied for a license within 120 days of a youth’s placement was 21.62% in the Pilot Teams. The provisional baseline rate for the Comparison Teams was 25%. The improvement benchmark for the Pilot Teams is to achieve a rate of 25%. Data for this reporting period is not available because this output measure requires that the youth be in the same placement for a minimum of 120 days.

ii. HMR/HFK Licenses Approved Within 270 Days of Placement

The second metric for this Intervention addresses the number and percentage of relative homes that become licensed within 270 days of placement of a youth in the home. DCFS is tracking successive six-month cohorts of kinship placements that met or exceeded the required minimum of 270 days in that placement.15

The provisional baseline performance for the Pilot Teams in the period July 2022 to

December 2022 was 19%, and the provisional baseline performance for the Comparison Teams was identical. Data for this outcome is not currently available during this reporting period because the outcome requires the placement to be active for a minimum of 270 days. DCFS has set a

15 DCFS and the Expert Panel made a decision to exclude from the metric those kinship homes that are temporary placements for youth who might be reunified with their parents or placed in another home. This metric accordingly will only count homes where a child remained in the placement for 270 days after the youth was placed in the home.

Case: 1:88-cv-05599 Document #: 833 Filed: 10/23/23 Page 20 of 30 PageID #:7923 benchmark for this metric of 23% for the latest two six-month cohorts that become licensed within

270 days.

iii. Status of Integration

At this time, the Department has not yet implemented integration strategies for improved

HMR/Fictive Kin Licensure in the Pilot Teams beyond the statewide strategies discussed in the

October 2023 Progress Report. Dkt. 832 at 16-20. The Department anticipates reporting on Pilot

Team-specific strategies in the next Integration Report.

E. The Subsidized Guardianship Intervention

The Subsidized Guardianship Intervention is one component of the Department’s strategy for achieving permanency for more youth more quickly. Data show that a substantial number of youth who linger in long-term care have been living in safe and stable relative or fictive kin placements for long periods of time. The Subsidized Guardianship Intervention targets these youth to ensure that the guardianship permanency option is being fully explored and actively pursued where appropriate.

i. Increased Assigned Guardianship Permanency Goal.

The targeted population for this measure is those youth in the same approved kinship home for longer than 270 days, with a focus on youth in care for longer than 24 months. These youth are most appropriate for assigning a goal of guardianship. The Pilot Teams provisional baseline for youth with an assigned permanency goal of guardianship is 20 youth (4%). The provisional baseline for the Comparison Teams was 2.65%. For this reporting period, 3.35% of youth in Pilot

Teams had a permanency goal of guardianship, while 4% of youth in the Comparison Teams had that permanency goal. The improvement benchmark for the Pilot Teams is 5%.

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ii. Improve Number of Youth Discharged Through Subsidized Guardianship

The provisional baseline for youth in care discharged to permanency through guardianship in the Pilot Teams is 4 youth (.8%) and none in the Comparison Teams. During the reporting period, neither the Pilot Teams nor the Comparison Teams had any youth discharged to permanency through guardianship.

identification of subsidized guardianship as a permanency goal and improved achievement of that goal for appropriate youth, beyond the statewide strategies discussed in the October 2023 Progress

Report. Dkt. 832 at 21-25. The Department anticipates reporting on Pilot Team-specific strategies in the next Integration Report.

F. The Administrative Case Review Intervention

The Administrative Case Review (ACR) Intervention is intended to enhance and reinforce several other SIP reforms. DCFS developed and tested substantial enhancements to the ACR process that added measures addressing the quality of casework. Most of those changes were implemented by September 2021.

i. Increased Attendance and Participation in the ACR

The key output for this Intervention addresses family and youth attendance and participation in the ACR. The provisional baseline participation percentages in the Pilot Teams were as follows: youth (12 and older) at 16.31%; Mother at 28.48%; Father at 26.32%; and Foster

Parent at 45.79%. The provisional baseline results for the Comparison Teams were: youth (12 and older) at 11.02%; Mother at 31.64%; Father at 24.12%; and Foster Parent at 41.74%.

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In the April 2024 Integration Report, DCFS expects to report the results of the first full data period for this Intervention.

ii. Improved ACR Ratings in Five Priority Areas

The key outcome for the ACR intervention is progressive improvement in the ACR ratings of the overall quality for five priority areas. The following graph shows differences in the five priority areas between the provisional baseline period16 and the first reporting period.

ACR quality ratings beyond the statewide strategies discussed in the October 2023 Progress

16 For the Quality of Case Planning category only, the provisional baseline period is from

September 1, 2022, to December 31, 2022. This baseline period is different because the Quality of Case Planning component of the new ACR process was not implemented until September 2022.

CFTM Case Planning In-person caseworker contacts

Family Visitation

Quality Supervision

Pilot Teams Baseline 31% 70% 72% 67% 52%

Pilot Teams Current 47% 45% 78% 73% 53%

Comparison Teams Baseline 26% 63% 78% 61% 64%

Comparison Teams Current 42% 63% 85% 77% 90%

Benchmark 50% 85% 91% 85% 85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ACR Ratings of Overall Quality for Five Priority Areas

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Report. Dkt. 832 at 25-28. The Department anticipates reporting on Pilot Team-specific strategies in the next Integration Report.

G. Performance on the SIP Satisfaction Criteria

The SIP will remain in effect until DCFS has achieved specific, state-wide improvement benchmarks referred to in the SIP as the Satisfaction Criteria.17 Dkt. 816 at pp. 35-38. In addition to state-wide data tracking, DCFS will also track progress on the metrics underlying the

Satisfaction Criteria in the Pilot and Comparison Teams.

i. Improved Permanency in 12 months for youth in care for 24 months

One Satisfaction Criterion addresses permanency in 12 months for youth in care for 24 months or more. The provisional baseline for the Pilot Teams on this metric was 19%. The provisional baseline performance for the Comparison Teams was 22%. For the reporting period, the performance for the Pilot Teams was 6% and the performance for the Comparison Teams was

8%. As noted above, it is too early to draw any conclusions from this data, because of the short amount of time that has passed and because integration of the Meta Model is only beginning in the

Pilot Teams.

ii. Reduced maltreatment among youth in care per 100,000 care days

A second Satisfaction Criterion addresses the rate of maltreatment for youth in care per

100,000 days in care. For the baseline period of July 1, 2021 to June 30, 2022, the rate of incidents of maltreatment among youth in care per 100,000 days in care in the Pilot Teams was 24.26, and the rate in the Comparison Teams was 23.96. The Department has determined that a full year of

17 The Satisfaction Criteria defined in the SIP are metrics that determine when the SIP ends and relate to state-wide improvement data. However, because DCFS finds what the Satisfaction

Criteria measure to be valuable, it will also track that data in the context of the Pilot Teams and report on them in the Integration Report. To be clear though, the Pilot Team performance around the measures underlying the Satisfaction Criteria has no effect on whether the SIP continues.

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iii. Reduced living arrangement moves for YNI Youth

The third Satisfaction Criterion is to decrease the number of living arrangements for

“Youth Needing Intervention” or “YNI” youth, defined as youth who have experienced four moves in a 12-month period when one move includes a psychiatric hospitalization. DCFS intends to achieve that reduction by implementing its new Well-Being Improvement Review and Linkage

(WIRL) process, which calls for early identification of YNI youth upon their fourth living arrangement move, and then providing high-level assessment and case planning resources to find creative and youth-centered supports meeting the youth’s immediate and long-term needs. Further, DCFS will be tracking whether the services identified in the WIRL process are delivered in a timely manner and will ensure that information about any resource shortages encountered in the

WIRL process is fed into DCFS’ resource development planning. The success of the WIRL process will be assessed by tracking reductions in the number of living arrangement moves experienced by YNI youth over the next 12 months following the initiation of the process.

Thirteen YNI youth have been identified in the Pilot Teams to date, and 19 have been identified in the Comparison Teams. Placement move data is currently not available for these youth because 12 months of follow-up is required to observe how YNI youth served in the Pilot

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Teams fare compare to those in the Comparison Teams. CFTMs have been conducted for the YNI youth in the Pilot Teams and recommendations have been made for services. Due to the complexity of these cases DCFS has identified specific individual clinicians who will work with the YNI youth in the Pilot Teams to develop innovative case planning, permanency options, and supporting services.

Over the next six months, DCFS will continue developing and refining the WIRL protocol.

DCFS developed a WIRL workgroup consisting of the B.H. Executive Administrator and staff from both the DCFS Clinical and Quality Enhancement divisions to further define roles and responsibilities for DCFS staff involved.

Going forward DCFS will be assessing not only the services being delivered to YNI youth, but the appropriateness of the services. DCFS has formed an additional workgroup, including

Professor Sonja Leathers, Ph.D.,18 from the University of Illinois at Chicago Jane Addams School of Social Work, that will develop data entry fields to document the steps of the WIRL process and to assist with the quality assessment. This quality assessment will evaluate the effectiveness of the WIRL intervention and services provided. Resource shortages identified in the WIRL process will also be tracked, and that information will feed into the Department’s Resource Development planning.

H. Expert Panel’s Observations

A key difference between the SIP and the previous Implementation Plan is the SIP’s premise that integrating the seven interventions will create a synergy that substantially – and measurably – improves the lives of youth in care. Evaluating the correctness of that premise

18 Dr. Leathers has direct practice experience with children and adolescents in foster care. She, along with her graduate assistant, will be interviewing caregivers to provide a qualitative assessment of the WIRL process.

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This approach requires DCFS to candidly confront obstacles and to commit to new approaches if the data do not show improved results. The Expert Panel and plaintiffs’ counsel have observed a positive dynamic in the approach of DCFS leadership to this project, for example in working to develop data collection and analysis systems, and to increase its engagement and more timely use of analytic resources from its university partners. The Expert Panel’s sense of a commitment by DCFS to implementing the SIP provides encouragement as the process moves forward.

Conclusion

The data related to the Meta Model integration into the Pilot Sites will guide the

Department’s ongoing evaluation of whether the SIP Interventions and the Meta Model are yielding significant changes benefitting youth in care. DCFS will continue its implementation efforts and work with the Expert Panel and Dr. Metz to coordinate and support work in the Pilot

Teams, clear barriers blocking implementation, and develop needed services and resources. The

Parties and Expert Panel remain committed to improving the performance of the Meta Model’s strategies.

Dated: October 23, 2023 Respectfully submitted, KWAME RAOUL

Barbara L. Greenspan Illinois Attorney General

Assistant Attorney General

100 W. Randolph St., 11-200 By: s/Barbara L. Greenspan__

Chicago, Illinois 60601 Barbara L. Greenspan

(312) 814-7087

Barbara.greenspan@illinois.gov

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Appendix A

Maltreatment in Care

To verify the suitability for comparison, DCFS examined the rates of maltreatment in care for FY 2022 (July 1, 2021 – June 30, 2022) for both the Pilot and Comparison teams and found the differences at baseline are ignorable within the bounds of chance variation.

FY22 (07/1/21 - 06/30/22)19

Pilot Comparison

Total Spells 670 531

Total Spells with >= 1 Maltreatment Report 41 6.1% 25 4.7%

Total Maltreatment Count 47 35

Total Days 193,709 146,078

Maltreatment Per 100,000 Days in Care 24.26 23.96

19 This data only includes maltreatments occurring after assignment to the Pilot and Comparison

Teams. The Maltreatment Data for FY22 is current through June 2023, meaning it is possible adjustments to the FY2022 data made after June 2023 are not reflected in this chart due to, for example, maltreatment investigations initiated in FY22 that conclude after June 2023.

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Permanency

DCFS also examined permanencies between the Pilot and Comparison Teams from July 1, 2021 to June 30, 2022 to verify suitability for comparison.