November 5, 2004
The Texas Department of Family and Protective Services (FPS) Advisory Council met at the Brown Heatly Building, Public Hearing Room, 4900 North Lamar, Austin, Texas. Council Members present were Chair Richard S. Hoffman and Members Dr. Ronald Brandon, Catherine Clark Mosbacher, Ommy Strauch, Judge Faith Johnson, Anne Crews, and John Castle. A quorum was present. Also present were Acting Commissioner Ben Delgado, and Department staff.
Agenda Item 1 – Call to Order
Chair Hoffman called the meeting to order.
Agenda Item 2 – Reading, Correction, and Approval of Minutes of September 10, 2004
Motion was made and seconded. The motion carried unanimously.
Agenda Item 3 – Public Testimony
There was no public testimony.
Agenda Item 4(a) – Commissioners Report
Anne Heiligenstein, Deputy Executive Commissioner, Health and Human Services Commission
Ms. Heiligenstein acknowledged the good work of Acting Commissioner Ben Delgado. The two candidates being considered are Carey Cockerell from Fort Worth, currently Chief Juvenile Probation Officer for Tarrant County; and Tom Papin, Executive Director of Health and Human Services for Mesa County in Colorado. Pat Devin will temporarily serve as Deputy Commissioner for FPS during the transition.
Ms. Heiligenstein reported that two weeks were spent conducting town hall meetings with all levels of staff in all state regions. APS and CPS reform efforts were a big part of the discussions. Ms. Heiliginstein presented summaries of both reform efforts, including outlines of presentations made to the state legislative committees.
Ms. Heiligenstein introduced Dr. Carmel Bitondo Dryer, Associate Professor at the Baylor College of Medicine, Director of the Geriatrics Program for the Harris County Hospital District, and Co-Director of the Texas Elder Abuse and Mistreatment (TEAM) Institute. Dr. Dryer provided an overview of the TEAM Institute timeline, and discussed grant funding projects. Dr. Dryer handed out the APS Fall newsletter, the APS Annual Report for 2003, and the proposals for the NIH interdisciplinary research effort and the CREST grant. She concluded by saying that the future success of helping elderly in need is to partner with the medical community for tele-help and research.
Mr. Brandon asked how many board certified geriatricians are in Texas. Dr. Dryer said there are 30 geriatricians in Houston and that there are 200 members of the Texas Geriatrics Society, the majority of who are board certified.
Agenda Item 4(b) – DFPS Tomorrow
Jane Norwood, Director, Center for Policy Innovation
Ms. Norwood presented on the agency’s leadership development program for managers, DFPS Tomorrow. Executive staff and upper and mid-level managers were the first to participate in September 2003; the next group to be trained will be program specialists. A pilot program will be offered this year for experienced workers who are considering moving into a supervisory position.
Ms. Norwood outlined the eight core competencies included in the program: Strategic Thinking, Change Management, Decision Making, Communication, Collaboration, Development of Self and Others, Cultural Competence, and Integrity. The five components of the program are Know DFPS; a 360-degree training program for assessment and feedback from both supervisors and peers; the Four Roles of Leadership Training program; Mentoring; and 40 hours of individually tailored Advanced Leadership Training. Ms. Norwood then gave detailed information about each of the five components. An evaluation of the program is planned, including pre- and post-scores on the Survey of Organizational Excellence, the aggregate of the 360 assessment, and the tangible and intangible results within DFPS. Ms. Norwood described the next steps are starting the first evaluation component, checking the evaluation plan for any needed corrections, and to re-develop the advisory committee composed of people completing the program from across the agency and from all levels.
Dr. Brandon asked for clarification that this is about training and supervision of staff, and Ms. Norwood replied that it is. He also noted that external evaluations of APS and CPS concluded that a lack of supervision and training exists and that there has been a 50% turnover rate. He asked if Ms. Norwood’s program adequately addresses these issues. She replied that in combination with regular training that first level supervisors receive prior to participating in DFPS Tomorrow, this training should help to address these issues, and added the question of whether supervisors have time to apply what they know.
Ms. Mosbacher asked if the Protective Services Training Institute is a national group. Ms. Norwood explained that it is a consortium of the Schools of Social Work at UT Austin, UT Arlington, and UH. DFPS Tomorrow contracts with them to provide training, and they use faculty and staff from other institutions in both Texas and nationally, depending on the need. Ms. Mosbacher also asked for clarification that the advisory committee would be composed of graduates of the program, and asked if they had considered bringing third parties onto that committee. Ms. Norwood said they had not specifically discussed that option as yet, and said there would be value to such an arrangement.
Mr. Hoffman asked if a consultant was used and how they accessed the Franklin-Covey material. Ms. Norwood said that it was developed in-house and that the original committee decided on Franklin-Covey as the best source for a 360 assessment that was appropriate across all levels of management and easy to administer.
Ms. Mosbacher added how important it is that staff get this type of training, and that she feels that this program seems to be a good way to help staff become better at what they do.
Ms. Norwood added that they had just completed a yearlong project looking at all of the standard supervisor training programs in place and found that they had each been developed individually and not as a coordinated group. They dissected each training program and then reconstructed them into a smooth continuum. They have currently been in the process of re-developing the individual programs and rewriting the curriculum, with help from the Protective Services Training Institute. She said they discovered that they were not getting the optimal effect from the training as it had been.
There was a discussion regarding a concern that the agency was sending out non-social service college graduates with no training specific to being APS workers and whether this training would address that. Ms. Norwood said that program evaluation work done this summer revealed that the supervisor training program needed some change, and that they are in the process of doing that.
Ms. Mosbacher stated one of the primary purposes for DFPS Tomorrow is to address the potential void created when a large percentage of regional directors would be retiring. Ms. Norwood said that professional development is a part of the program. Additional issues are the number of workers per supervisor ratio and that the agency doesn’t have tenured supervisors.
Ms. Heiligenstein confirmed that practice skills are critical for both supervisors and workers, and that reform efforts are targeting this. There is great concern that tenure in CPS unit supervisors has dropped two years in two years, and that it is critical for reform efforts to address training of supervisors for both APS and CPS to stabilize turnover.
Agenda Item No. 4(c) – Legislative Update
Ms. Jennifer Sims, Director, Center For Consumer and External Affairs, reported they have started training staff on how to use a new computer system to track legislative bills, and in November and December will be training the new Commissioner, Deputy Commissioner, and Assistant Commissioners, as well as anyone else in a position to testify during the legislative session. Ms. Sims said they are working with HHSC on the CPS and APS reform to generate legislative initiatives. Three staff members are dedicated to Government Relations, one of who will soon be moving to the Governor’s Office. Ms. Sims stated they plan to hold meetings on almost a daily basis with the executive team look at the hot issues, and they will also communicate with the Council regularly to keep them updated.
Ms. Sims reported that they expect a few more legislative hearings that focus on the agency before the session starts by Senator Nelson with HHS regarding CPS; and Rep. Uresti in the House Human Services Committee regarding CPS and APS. Ms. Sims noted that pre-filing of bills starts November 8th, the first day of the new session is January 11, 2005, and March 11th is the last day that new bills can be filed.
Ms. Mosbacher asked how Government Relations works with the Commission under the new structure. Ms. Sims replied each agency has its own Government Relations division that works closely with HHSC. Although there had been a suggestion to form an enterprise Government Relations shop, it was recognized that the commissioners of each agency need to have their own staff closely aligned with them and with their individual programs.
Mr. Hoffman asked what the policy is regarding advocacy groups calling for information. Ms. Sims said they provide advocates and stakeholder groups with information regularly. Before the new legislative session, they will have a plan for how they can communicate with stakeholders more effectively.
Dr. Brandon, noting the power in the “Silver Haired Legislature,” asked if they are seen as stakeholders and wondered about communication with them. He also asked how they are informed about agency priorities. Ms. Sims said that they are certainly on the stakeholder list and will be worked with. She added that informing them about priorities is a challenge because of the danger of engaging in lobbying, but that they will be provided with information so they can draw their own conclusions.
Ms. Heiligenstein said that they would be providing the Governor and the Legislature with final reports of the program reviews of both APS and CPS. So far, the 90-day report from CPS has been issued which outlined some immediate steps taken to address current concerns. The final report from APS is being completed and will be submitted to the Governor next week, which will include the Commission’s recommendations for changes in APS. The final CPS report will be provided on December 31st. Both reports will lay out problems as well as possible solutions. One of the primary issues is that of heavy workloads, which has led to some noncompliance with policies and procedures. With the size of caseloads and the turnover rate among unit supervisors, improvements will require a significant addition of resources. She said they will be working closely with the Legislature on that. She added that the APS and CPS reports will be posted on the HHSC and DFPS web sites.
Dr. Brandon asked about the timeline for the introduction of the bills and if the CPS report would be distributed in time. Ms. Sims said that filing of bills begins November 8th and runs through March 11th. She added that some bills that get filed may be “placeholders” that get fleshed out as the session progresses.
Ms. Heiligenstein acknowledged the hard work of Ms. Sims and her team, and said that she expects that this session will be a full and rather difficult one.
Agenda Item No. 4(d) - Statewide Intake
Terri Ware, Director, Center for Program Coordination, gave a report to the Council on Statewide Intake. Ms. Ware reviewed with the Council that her department serves as the central point of contact within DFPS for all reports of abuse, neglect, and exploitation, and they are open 24/7. She said that they historically have two busy seasons. One is in April/May and is primarily due to child abuse and elder abuse prevention efforts statewide. The other is in September/October after school starts.
Ms. Ware outlined three ways that information comes into Statewide Intake. There has been a significant reduction in abandoned calls and average hold times. Reporting via the Department’s web site was advertised to school professionals in August and there was a dramatic increase in the number of e-reports received in September and October. All reports received are assessed to determine if they meet the statutory definition of abuse, neglect, or exploitation. If so, the reports get assigned to the appropriate program for investigation. Ms. Ware acknowledged the improvements as being a team effort, and gave credit to those answering the phones, the management team, and the various support divisions.
Chair Hoffman, referring to the efforts to reach out to school professionals, asked what about nutritionists and doctors? Ms. Ware said that their stats revealed that about 28% of calls came from school professionals. She acknowledged the need to reach out to medical professionals, as has been done in the past. Mr. Hoffman commented that, given the use of the Internet, the numbers seem small. Ms. Strauch asked for a comparison between the number of calls for 2003 vs. 2004. Volume for 2003 was a record and 2004 is slightly less.
Dr. Brandon said that the Internet is working very well for case management, which is a real step forward. He asked if there is a breakout of trends of calls with APS as opposed to CPS Ms. Ware said they do have that information. Dr. Brandon asked if the numbers have changed any since last year. Ms. Ware said they have stayed fairly consistent. She said that the intakes assigned over the past two years for all programs has been 37%, and the numbers for APS have risen slightly, but the deviation from the average has not varied much month to month.
Chair Hoffman asked if the drop from 18 minutes to 4 minutes hold time was due just to there being more staff. Ms. Ware said that the improvement is from a combination of technological improvements, more people, and benefits of online reporting. Mr. Hoffman asked if people are more reluctant to email than make a phone call, or are they just not used to it? Ms. Ware said that surveys have shown that people love the e-reporting, but there is no survey data regarding use of the phone. Callers are told what the average hold time is and that they can report on the Internet, and she thinks that some people prefer to talk to a worker. Mr. Hoffman asked if the dropped calls statistic includes those who hang up after being told about e-reporting, and Ms. Ware said it does.
Ms. Mosbacher asked for clarification about how to read the chart in the handout regarding the call volume comparison for the past two years. The figure for 2003 may be larger in part because it may include people calling multiple times rather than holding when they can’t get through initially. Ms. Mosbacher asked if advocacy centers were receiving report calls. Ms. Ware said that actual reports should come in to the central number rather than be handled locally.
Agenda Item 4(e) – Advancing Residential Child Care
Mr. Moe Dozier reported that they are working on guidelines for the use of psychotropic medications in foster care, and a report on this was submitted to Commissioner Chapmond on September 13. Dr. Charles Bell, Deputy Executive Commissioner for Health Services at HHSC, and Dr. Sanchez, the Commissioner at the Department of State Health Services, are leading the efforts to review the recommendations and take action on them. Due to work from the Psychotropic Medication Advisory Committee and tools that are included in the report, they have deleted the Psychotropic Medication, Restraints, and Seclusion outcome from the outcome report. They are reviewing the 2004 data to see what improvements can be made to the outcomes methodology. Mr. Dozier added that they are coordinating their work with the CPS reform efforts, and that in the area of expanding services they have mapped their placement needs and begun meeting with local providers and local staff (e.g. Dallas and Lubbock).
Mr. Dozier said that another area they are working on is the coordination and monitoring of residential childcare services. They are looking at Youth for Tomorrow, CPS residential childcare licensing, and contract management. They will be working with the Assistant Commissioners to develop a plan to better coordinate monitoring efforts. Mr. Dozier said that their goal is to have that plan ready in March of 2005 and in place by September 2005.
Mr. Dozier reported that they have been working on reviewing the STEP Committee recommendations and other innovative approaches. He said that their New Initiative Sub-committee of the ARC Advisory Committee has completed their report and submitted it to HHSC.
Ms. Strauch commented about how important it is for providers to feel they are being listened to, and that the progress is steady and in the right direction—not a quick fix. Ms. Mosbacher asked for a copy of the STEP report for all the good information that was gathered.
Dr. Brandon raised a concern that the provider is again being measured on an outcome that they don’t have control over, namely children who are placed. He asked Mr. Dozier how he is addressing that. Mr. Dozier said they are looking at all the methodology to see where improvements can be made. Some good suggestions have come from the provider community and their own staff, especially regarding adaptive functioning. They are also looking at how they use the data and how it should be reported. The Quality Assurance Work Group will handle that.
Ms. Heiligenstein highlighted the need for a high level of medical consultation for children in foster care so that both their psychiatric and medical needs are monitored and tracked as they move from place to place, and that Dr. Charles Bell is looking into that currently. This is also an issue for Medicare children. Ms. Heiligenstein added that she is pleased to see how well these needs are being handled since the recent changes in the agency.
Dr. Brandon, noting that 1/3 of the state’s children are overweight, asked if there has been attention to the health issues of children, such as nutrition and exercise. Ms. Heiligenstein said that it has been looked at, although not for this population. One of the issues her staff is currently working on is childhood obesity and Type II Diabetes, and she believes that serious efforts need to be made here to avert a much bigger problem. They have been working with Dr. Sanchez’s staff, and Commissioner Combs and Governor Perry have both been active in this area. A statewide effort by the Commissioners and their agencies to address obesity and Type II Diabetes is being looked at, and all children in the state would be targeted. Dr. Brandon noted the opportunity here for a pilot study that could serve as a model for other states.
Agenda Item 5 – Update of Previous Business Before the Council
Mr. Gerry Williams reported on the rules that were before the Council previously. Two rules were presented in the July 9th meeting. The first amended the current Licensing rule by adding the grounds of falsification of records as a basis for remedial or adverse actions taken against a childcare operation. The second rule amended the CPS allegation disposition from “Moved” to “Unable to Complete”. No public comments were received on either rule. They were adopted subsequent to the September Council meeting by Executive Commissioner of HHSC, Albert Hawkins, and they became effective October 1, 2004.
Two additional rules were presented to the Council at the September 10th meeting. The first amended several of the current Licensing rules regarding therapeutic camps, and the second amended the current CPS rule by limiting the circumstances under which a good cause of exception may exist for audiotaping or videotaping first contacts with alleged victims of physical or sexual abuse. Both rules were approved for publication by HHSC. The rules will come back to the Council in January after time for public comment.
Agenda Item 6 - Adjourn
No other business was presented, and Chair Hoffman adjourned the meeting at 11:15am.