Official Oversight of the Washington State Foster Care System Nears Completion

By Anisha Asher

This summer marked the final official report of the panel of experts assigned to oversee reform of Washington State’s foster care system.  In June 2013, the Braam Oversight Panel released its fourth and final monitoring report based on the Revised Braam Settlement and Exit Agreement, a revised version of a settlement agreement reached in 2004 between the State and foster children. The report details the performance of Washington State’s Department of Social and Health Services (DSHS) on 21 outcomes in the reporting period from July 1, 2012 to December 31, 2012. The outcomes measure the experiences of children in foster care; for example, one outcome looks at how many children are forced to change schools because of a change in foster care placement. They also look at how DSHS fulfills its obligations, such as how often caseworkers visit foster children, and how well foster parents are trained. Of the 21 outcomes, DSHS had achieved full compliance for five outcomes before this reporting period. DSHS achieved full compliance for seven outcomes during this reporting period, and failed to achieve full compliance for another seven outcomes. Two outcomes were not reported in the final Braam Oversight Panel report because the data, which is reviewed annually, was not due for this report.

Background: Braam v. State of Washington 

The Braam Oversight Panel was originally created to monitor a settlement agreement in the Washington Supreme Court case Braam v. State of Washington. The Braam lawsuit was originally filed in 1998 on behalf of a class of plaintiffs that included “all children who are now (or who in the future will be) in the custody of the Department of Health and Social Services foster care system and who while in DSHS custody are placed by the Defendants in three or more placements.” ¹

Braam ultimately settled in 2004. As part of the Settlement Agreement, the Braam Oversight Panel was created to monitor improvements in Washington State’s foster care system.² The Panel issued 10 reports under the original Braam Agreement.³

On November 1, 2011, DSHS and plaintiffs’ attorneys reached a Revised Settlement and Exit Agreement.⁴ The Revised Agreement extended the Braam Settlement for 26 months, ending December 31, 2013.⁵ The Revised Agreement details 21 enforceable goals, and identifies the full compliance measure, data source and reporting periods for each outcome.⁶

Differences between the Original and Revised Settlement Agreements

The Revised Settlement and Exit Agreement differs from the original Settlement Agreement in a number of ways. First, it speeds up the timeframe for the State to be free from official monitoring, if they are fully in compliance with a given outcome. According to the Revised Agreement, if DSHS has achieved full compliance with any particular outcome for 18 consecutive months, that outcome will no longer be monitored by the Plaintiffs.⁷ Under the original Agreement, DSHS had to achieve full compliance for two consecutive years.⁸

Second, the data sources used to provide data for some outcomes also have changed. In the Revised Agreement, data sources have been expanded to include administrative data, case review processes, and foster parent surveys conducted by DSHS instead of Washington State University.⁹ Due to the changing data sources, it is not possible to compare DSHS’s performance in and before 2011 to its performance after 2011.¹⁰

Finally, the statewide foster care system used to be organized into six regions, and data was provides separately for each. During the life of the settlement agreement, the regions were consolidated from six to three, meaning it is no longer possible to compare DSHS’s performance by region across time.¹¹

Outcomes Met in Final Monitoring Report

There are 21 enforceable outcomes listed in the Final Monitoring Report. The Revised Settlement and Exit Agreement defines “outcome” as “a specific and measurable result consistent with the Professional Standards developed by the Oversight Panel and agreed to by the parties…that is intended to promote systemic improvement in the delivery of child welfare services by DSHS to the children in the Plaintiff Class.”¹² For each outcome, the Braam Oversight Panel monitored whether DSHS had achieved the “full compliance measure.”

To achieve full compliance for a particular outcome, DSHS had to show that its statewide performance met the standard set by the Braam Oversight Panel and that each region performed no lower than 10 percentage points behind the state as a whole. This protected foster children in all regions of the state by ensuring that the state could not reach full compliance if one region was performing particularly poorly, even if the state average met the standard. For five of the 21 outcomes in the Report, DSHS achieved full compliance for 18 consecutive months prior to the reporting period, so those outcomes were not monitored. Data was not due for two outcomes listed in the Final Report, so those were not reported. Of the remaining 14 outcomes, DSHS achieved full compliance for seven, and failed to achieve full compliance for another seven.

Outcomes for Which DSHS was in Full Compliance Prior to This Reporting Period

Outcomes for Which DSHS was in Full Compliance This Reporting Period

Two Outcomes for Which Data was Not Due

For five of these outcomes, DSHS not only met but also exceeded the full compliance measure in this reporting period. For example, for Outcome 7, DSHS placed 87% of children statewide with siblings also in out-of-home care, where the full compliance measure was 75%.¹⁶ All three regions of the state also exceeded this measure, placing 83%, 100%, and 78% of children with siblings in Regions 1, 2, and 3, respectively.¹⁷ For Outcome 16, DSHS exceeded the full compliance measure by 4%, placing 99% of children statewide identified as SAY with trained and prepared caregivers.¹⁸ Each region also fulfilled the compliance measure, with 100%, 96%, and 100% of children appropriately placed in Regions 1, 2, and 3.¹⁹ For Outcome 17, DSHS exceeded the full compliance measure by 3% at the state level, placing 98% of children identified as PAAY with trained and prepared caregivers.²⁰ DSHS also exceeded this goal at the regional level, placing 100%, 96%, and 100% of children in each respective region with appropriate caregivers.²¹ For Outcome 19, DSHS exceeded the full compliance measure by 2% at the state level, holding staffing meeting for 97% of youths transitioning to independence.²² Each region also exceeded the full compliance measure by 2 or 3%.²³ For Outcome 4, DSHS met its benchmark of screening 90% of children for mental health and substance abuse needs every 12 months.²⁴ Regions 2 and 3 also met the full compliance measure, while Region 1 exceeded it by 1%.²⁵ Finally, for Outcome 5, DSHS met its statewide goal of investigating 95% of child abuse and neglect referrals, but Regions 1 and 2 fell short of the goal.²⁶

Improvement Still Needed: Outcomes Not Met in Final Monitoring Report

While DSHS’s performance in the above areas is commendable, it failed to meet full compliance on the following seven outcome measures, indicating a need for improvement in particular areas.

Outcomes for Which DSHS Failed to Meet Full Compliance

Although DSHS has fallen short of full compliance measures for these outcomes, Children’s Administration of DSHS has proposed various strategies to improve performance in each area.

Caseworker visits have been a major focus of the Braam reform effort for many years. Although DSHS is much closer to visiting the children in its care at least once a month, it has still not reached full compliance. For Outcome 1, DSHS should have achieved 90% compliance with the goal of giving each child a visit by an appropriate worker at least once a month.²⁸ However, statewide, 85% of children received monthly visits.²⁹ Each region also fell short of full compliance, with 83%, 89%, and 82% of children receiving monthly visits in Regions 1, 2, and 3 respectively.³⁰ For the next reporting period, Children’s Administration intends to continue its quality assurance process to review cases where monthly visits did not occur to determine the reasons for the missed visits.³¹ The Braam Panel noted that it would like more detail on this process, and would also like to see data regarding the frequency and reasons for missed visits.³²

Caseworker caseloads also are nearing the level of compliance, but are still not quite there. For Outcome 2, DSHS fell short of the full compliance measure (90%) by 2% at the state level, where only 88% of caseworkers had caseloads at or below 18.0 cases per caseworker.³³ Region 1 exceeded full compliance at 92%, while Regions 2 and 3 fell short, with 89% and 84% of caseworkers in compliance.³⁴ To improve, Children’s Administration has proposed continued monitoring of caseworkers’ caseloads, and reallocation of caseworkers as needed.³⁵ It also intends to continue the use of Permanency Roundtables, a strategy designed to expedite permanency, for a variety of children.³⁶ Finally, Children’s Administration proposed the continued use of Unified Home Studies — a single approval process for foster care and adoption home study applicants — to speed up the processes of adoption and guardianship.³⁷ The Braam Panel did not have concrete comments regarding these strategies, and only noted that it desired “further discussion” at its final meeting in June 2013.³⁸

Children still are not receiving visits with their siblings at the required levels, though performance in this area is improving. DSHS fell below full compliance by 15% statewide for Outcome 8.³⁹ Only 75% of children placed apart from siblings had two or more monthly visits with their siblings.⁴⁰ Each region also failed to meet compliance: only 72%, 70%, and 80% of children participated in sibling visits in each respective region, though the full compliance measure was 90%.⁴¹ It should be noted that this is a dramatic improvement from the last reporting period, in which statewide compliance was only 38%, and each region’s compliance was 33%, 37%, and 45%.⁴² The improvement from the last period indicates that previously implemented strategies are working. To improve its performance further, Children’s Administration intends to continue a quality assurance process to monitor cases and strategies implemented.⁴³ It will also examine barriers and solutions to the practice of sibling visits.⁴⁴ Finally, an email template for documenting sibling visits will be distributed to social workers to simplify the addition of sibling visit details to each child’s case notes.⁴⁵ The Braam Panel again did not have concrete comments, but did ask for further discussion of strategies at its June 2013 meeting.⁴⁶

DSHS’s performance in providing of information about foster children to their caregivers is dismal. For Outcome 11, DSHS fell below the full compliance measure of 90% by 66%.⁴⁷ Only 24% of caregivers statewide received timely and appropriate information about the children placed with them. Regions 1, 2, and 3 only achieved 26%, 20%, and 25% compliance, respectively.⁴⁸ This was DSHS’s most egregious failure as reported for July through December 2012. Prior to the January-June 2012 reporting period, compliance was close to the full compliance measure benchmark.⁴⁹ But for that period and the July-December 2012 period, a new data source was used to measure DSHS’s performance.⁵⁰ Earlier data was based on a survey of foster parents and caregivers conducted by Washington State University.⁵¹ More recent data is based on a targeted case review, as required by the Revised Settlement Agreement.⁵² This change in data source likely impacted the measurement of DSHS’s performance.

Children’s Administration has proposed several strategies for improvement in providing information to foster parents about children placed in their care. It intends to implement a quality assurance process to monitor the strategies implemented, the barriers to and successes of, performance.⁵³ It proposed discussion of a new curriculum segment for social workers focusing on the Child Information Placement Referral Form.⁵⁴ It also proposed distribution of a tip sheet to promote effective use of the Form, along with a discussion of other strategies to promote utilization of the Form.⁵⁵ The Braam Oversight Panel was understandably concerned by DSHS’s poor performance on this outcome. It suggested a discussion of what lessons were learned from implementation of particular strategies.⁵⁶ Furthermore, it emphasized a need to share the Form with caregivers within specified time frames, and highlighted the role supervisors can play in ensuring that caregivers are provided with information in a timely manner.⁵⁷ Finally, the Panel noted that a mechanism should be imposed to ensure that emails with important information are actually received by caregivers.⁵⁸

DSHS also needs to improve its provision of care for medically fragile children, though it is close to full compliance. Outcome 18 dictates that 95% of medically fragile children should receive appropriate medical care and placed with trained caregivers, but only 92% of such children statewide were connected to appropriate care.⁵⁹ Region 1 met the full compliance measure, with 100% of children connected to appropriate care, but Regions 2 and 3 did not, with 83% and 90% compliance, respectively.⁶⁰ To improve, the Fostering Well Being Care Coordination Unit nurse and Medically Fragile lead will coordinate emails and phone calls regarding medically fragile children.⁶¹ FamLink pages have also been updated to document medically fragile children, and alert social workers if a child is diagnosed as medically fragile.⁶²

DSHS still has a long way to go in its ability to care for foster youth who run away, as shown by the data for Outcomes 20 and 21. 3.27% of youth in out-of-home placements statewide run away, while the full compliance measure for Outcome 20 requires that 2.35% or fewer do so.⁶³ Full compliance also requires that fewer than 2.59% of children in each region run away from placements.⁶⁴ Each region individually does not meet full compliance, with 2.45%, 4.04%, and 3.27% of youth running away.⁶⁵ For Outcome 21, DSHS was to reduce the number of days that children were on runaway status. The full compliance measure is 25.0 days, with regional performance at 30.0 days or less.⁶⁶ DSHS fails to meet this at every level, and by a large margin. Statewide performance is 59 days, and regional performance is 66, 52, and 61 days.⁶⁷ To improve performance in the area of runaway youth, DSHS will focus on finding youth that have been missing from care for over 90 days, and adopt methods that have been shown in national research to be effective.⁶⁸ It will provide Missing from Care training and resources to caregivers and runaway youth, and continue a workgroup to discuss strategies for improvement in this area.⁶⁹ It had also suggested the addition of youth to the workgroups, and requested updates regarding the youths’ contributions.⁷⁰

Conclusion

The Final Monitoring Report of the Braam Oversight Panel reveals that Washington’s DSHS has improved significantly in many areas since the Braam lawsuit was settled and the State embarked on its reform efforts under the settlement agreement. However, there is still room for growth. Children in out-of-home placements must be visited more frequently by caseworkers, and should have more sibling visits. Caseloads managed by individual caseworkers should be reduced. Caregivers must be given information regarding children’s needs in a timely manner, especially if the child is medically fragile, for the safety of the child. Finally, DSHS must work to improve its treatment of runaway youth by implementing strategies that will reduce the number of runaways and the amount of time children in placements are missing.

Anisha Asher was a 2013 summer law clerk at NCYL, working with Senior Attorney Bill Grimm researching psychotropic medication policies concerning foster care youth. Anisha is in her second year at University of Michigan Law School.

1. Braam ex rel. Braam v. State of Washington, 81 P.3d 851, 855 (2003).
2. See Braam v. State of Washington Final Settlement (2004) at 1, braamkids.org/SettlementAgreement.pdf.
3. Braam Oversight Panel, Introduction to Braam Revised Settlement and Exit Agreement Monitoring Report—July-December 2012 (2013) at i.
4. Braam v. State of Washington Revised Settlement and Exit Agreement 1 (2011), www.dshs.wa.gov/pdf/ca/Braamagreement103111.pdf.
5. Braam Oversight Panel, Introduction to Braam Revised Settlement and Exit Agreement Monitoring Report—July-December 2012 i (2013).
6. See Braam v. State of Washington Revised Settlement and Exit Agreement 5 (2011), www.dshs.wa.gov/pdf/ca/Braamagreement103111.pdf.
7. See Braam v. State of Washington Revised Settlement and Exit Agreement 4 (2011), www.dshs.wa.gov/pdf/ca/Braamagreement103111.pdf.
8. See Braam v. State of Washington Final Settlement 4 (2004), braamkids.org/SettlementAgreement.pdf.
9. Braam Oversight Panel, Introduction to Braam Revised Settlement and Exit Agreement Monitoring Report—July-December 2012 ii (2013).
10. Id. at 5.
11. Id.
12. See Braam v. State of Washington Revised Settlement and Exit Agreement 3 (2011), www.dshs.wa.gov/pdf/ca/Braamagreement103111.pdf.
13. Braam Oversight Panel, Braam Revised Settlement and Exit Agreement Monitoring Report—July-December 2012 v (2013).
14. Id.
15. Id.
16. Id. at 17.
17. Id. at 18.
18. Id. at 32.
19. Id. at 33.
20. Id. at 34.
21. Id. at 35.
22. Id. at 39.
23. Id. at 40.
24. Id. at 13.
25. Id. at 14.
26. Id. at 15.
27. Id. at iv.
28. Id. at 7.
29. Id.
30. Id. at 8.
31. Id. at 9.
32. Id.
33. Id. at 10.
34. Id. at 11.
35. Id. at 12.
36. Id.
37. Id.
38. Id.
39. Id. at 19.
40. Id.
41. Id. at 19-20.
42. Id.
43. Id. at 21.
44. Id.
45. Id.
46. Id.
47. Id. at 26.
48. Id. at 27.
49. Id. at 26.
50. Id. at 27.
51. Id.
52. See Braam v. State of Washington Revised Settlement and Exit Agreement 9 (2011), www.dshs.wa.gov/pdf/ca/Braamagreement103111.pdf.
53. Braam Oversight Panel, Braam Revised Settlement and Exit Agreement Monitoring Report—July-December 2012 28 (2013).
54. Id.
55. Id.
56. Id.
57. Id.
58. Id.
59. Id. at 36.
60. Id. at 37.
61. Id. at 38.
62. Id.
63. Id. at 41.
64. Id.
65. Id. at 42.
66. Id. at 44.
67. Id. at 45.
68. Id. at 46.
69. Id.
70. Id.