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North Carolina’s Department of Health and Human Services provides guidance and training for child protective services divisions within county-level social services agencies.
Then it’s up to local departments of social services in each of the 100 counties to interpret and enact the policies.
More than 1-in-5 counties deviate from the state-approved intake procedures, according to an analysis that a legislative agency released in November 2019.
Legislative evaluators worried the deviations could mean children in these counties have different outcomes because some of those local choices stray from federal and state law in ways that harm children and families, while also creating liability for the counties.
Lack of data
One major obstacle to equitable treatment is missing information to track outcomes across the state.
A 2020 report from the General Assembly’s Program Evaluation Division said, “The absence of accurate program data compromises DHHS’ ability to oversee county Child Protective Services.”
Part of the problem is the counties’ inconsistent use of a case management system called NC Fast.
Despite state and federal government expenditures of more than $108 million on the child welfare module alone as of early 2020, with millions more on other portions of the program, only 11 counties use it for ongoing services such as in-home services, permanency planning and adoption, and only 29 counties use it for intake and assessment, according to the 2019 DHHS North Carolina Child and Family Services Plan
NC Fast is supposed to track a multitude of social service office functions, including Medicaid services, food and nutrition services and federal programs like Temporary Assistance for Needy Families. State leaders also wanted it to save time for social workers.
Lawmakers heard an update to NC Fast at a committee hearing in late 2019. At the time, about a quarter of the 100 counties were using NC Fast.
Sen. Carl Ford, R-Rowan, expressed his frustration with the software after the state waited more than a decade and spent tens of millions of dollars of taxpayer money on it.
“We jokingly call it NC Slow because it’s terrible,” Ford said. “It takes up too much time. And it just doesn’t work, and we’ve wasted millions of dollars on it.”
Child welfare staffs across the state have balked at using it for a variety of reasons, a state report said.
“We still have a desire to enter into the statewide automated case management system,” said Paige Rosemond, Child Welfare Division director in Wake County.
“But we have been waiting on this solution now for a decade-plus and still do not have a statewide automated case management system.”
Instead, social workers in Wake County use Excel spreadsheets and manual data entry to track cases.
“That worries me,” she said.
As of 2020, around 3-in-5 counties still used paper to track child welfare cases, and some track cases with their own, in-house electronic systems. The functionality of the state system came online in pieces, one module after the other, with child welfare being the most recent.
This places children at risk, program evaluators said, because “counties are not equipped to share real-time information with each other or the state.”
“For example, if a paper-based county screens in a report alleging serious abuse or neglect and there is no follow-up on that intake, DHHS — and potentially the county itself — has no way to be alerted in real time that required action was not taken,” evaluators said.
“Inaction potentially places a child or children in danger and is a violation of state law.”
As social workers around the state make contacts with parents, take notes, dispense advice or take children to safer homes, the workers return to their offices. They record their efforts and decisions in checkboxes or phrases, then write down parent names and those of all other adults living in a home.
In Wake County, social workers key the data into both a state and a local system, in addition to filing paper reports with additional data the state wants.
“These systems do not ‘speak’ to each other,” Rosemond said. “Also, the state requires us to report on data that is not contained in their state systems.”
Social workers maintain data locally to analyze their performance, she said. The county also reports this information to grant funders and foundations.
Absent a statewide automated system, as NC Fast is intended to be, social workers make do with what they have. Wake County social workers track cases with Excel spreadsheets and Lotus Notes, a word processing and email program that was popular 30 years ago.
Getting data to the state takes extra steps through additional people, which has the possibility of introducing errors at each point, Rosemond said.
“As a result, there are discrepancies between our local and the state’s data,” Rosemond said.
Social workers send their paper reports to a centralized unit with access to the state system. Those workers then key in the information into the state system, or they send reports back to the original workers for changes.
North Carolina started rolling out its child welfare module, called Project 4, in 2017. However, that rollout was delayed after several counties balked at inconsistent performance.
For instance, when the system was down for upgrades, workers could not read or write information to NC Fast. And if social workers enter data incorrectly, the system won’t let them correct the errors, the state Program Evaluation Division report said.
Buncombe County’s DSS office allocated $400,000 for extra clerical staff when it thought it would be required to use NC Fast’s child welfare modules, but its current system has more features that child welfare workers need than NC Fast does, said Stoney Blevins, director of health and human services in Buncombe County.
“I would support a statewide child welfare data management system,” he said.
“I mean, that would be helpful to children, and to counties, you know, especially when families move across county lines. Child welfare is like any other issue: It doesn’t really care about the county line. So, I do hope we get a good product.”
The topic is a sour one for state Sen. Joyce Kraweic, R-Forsyth, chairwoman of the Senate Committee on Appropriations on Health and Human Services. When asked why it was taking so long for NC Fast to come to fruition, she expressed exasperation.
“FedEx can track a package and tell you where it is every step of the way, and all about it,” she said this week.
“We can’t keep up with our children and where they are in NC Fast. And there’s no excuse for it.”
Some counties also enter data inconsistently. Some include less information, and others include more about families or children. Without a unified case management system, counties do not have access to standardized reports so they can monitor their own performance, program evaluators said.
DHHS officials, who indirectly oversee local Department of Social Services offices in the state’s 100 counties, agree with some of the findings of the evaluators, according to an agency response to the 2020 report about NC Fast. But even the best computer program will not, on its own, better help families.
“As we move toward a statewide child welfare case management system, concerted efforts must be made to address the staffing needs in child welfare both at the state and county level,” said Tara Myers, deputy secretary for human services, in her response.
When someone reports child abuse or neglect, a 24-hour clock starts ticking. Depending on the nature of the abuse and the seriousness of the allegation, a social worker decides whether or how quickly to investigate — a process called intake screening.
When a child is being harmed or is in imminent danger of being harmed, DSS is obligated to respond within 24 hours. Other situations require a more nuanced approach, which includes whether to bring the family into the system at all or offer support.
A survey of social workers and their supervisors by the General Assembly’s Program Evaluation Division two years ago said employees correctly screened hypothetical abuse, neglect and dependency scenarios 71% of the time. That this rate was not much higher represents a concern in the study, which the Program Evaluation Division said stemmed from a lack of retraining requirements.
However, a representative for the state’s social services directors said the study was flawed.
The state intake policy requires “a two-level decision-making process for every allegation received,” said Kim Harrell, president of the N.C. Association of County Directors of Social Services, in a letter in response to that PED report.
“Requiring two persons to jointly evaluate the (abuse or neglect) report and review the tools/policy contributes to more consistent screening than reflected in the PED Evaluation,” she wrote.
A survey of state DSS directors showed two-thirds of directors said the state did not offer training for intake screening often enough.
It also showed 22 counties that had local intake procedures different from those set by state and federal policies. Some counties even used processes that were in direct conflict with state policy, according to the report published in early 2020.
However, even training won’t keep social workers and their bosses in line with state law and policy if they ignore the training.
Multiple social workers in Cherokee County’s Child Welfare Division testified last month that they questioned the legality of a local “Custody and Visitation Agreement” form, or CVA, to separate families without judicial approval when legal arguments were weak or they had “stuck cases.”
The former DSS director told social workers who raised objections to follow the DSS attorney’s advice. Both the former director and former attorney are under indictment for their role in the CVAs. The use of CVAs came to an end in early 2018, when a judge ruled the documents void and called them unlawful.
During a resulting federal civil trial last month, in which one of the affected families sued the county and former officials, social workers testified that supervisors were pressured to close cases because of concerns about escalating costs to help families. Brian Hogan and his daughter won a $4.6 million jury verdict.
Rather than following policies outlined by the state and federal governments — which says parents and children are entitled to legal representation and to have permanent custody decisions adjudicated by a judge — social workers testified they followed a process authored by then-DSS attorney Scott Lindsay.
A judge asked Lindsay under what authority he created the document. He told her, “None.”
Oversight and support
State Sen. Kraweic has followed child welfare cases for years. Often there’s not enough oversight, she said this week.
“I know that many times, policies are not being followed at the county level, and nobody even knows about it until something happens,” she said. “And then you find out well, they haven’t been following policy all along.”
Legislation passed in 2017 called Rylan’s Law included a plan to provide more support to local DSS offices, called a regional support model.
“This includes two positions that will provide a more timely response to counties regarding Child Protective Services cases,” said SarahLewis Peel, a spokeswoman with DHHS, in a statement to Carolina Public Press this week.
“It’s important to note that the General Assembly needs to provide funding and new positions for the regional offices.”
That could change soon, as legislators have made incremental progress toward a state biennial budget. Kraweic said among her top priorities is funding for the state child welfare system.
“Everything that’s surrounding these children is a priority for me so that we get them in stable homes,” she said.
However, the new regional offices are limited in scope and will primarily provide guidance and support. It’s not clear that they will have much power to correct local officials who insist on making up their own rules.
Rylan’s Law also allows DHHS to intervene in some cases, taking temporary control of Child Protective Services. This happened after news reports on Cherokee County went public in early 2018. But the takeover was also limited in scope.
Although the former DSS director was suspended, DHHS did not prevent local officials from rehiring her in a different position, despite an ongoing criminal probe. Massive and still-unexplained shredding of documents took place at the agency shortly after she took the new position.
Pay, training and policy disparities
Differing policies are only part of the challenge. North Carolina counties have wide pay disparities for the same child protective services positions, which local tax dollars help fund.
The counties that pay social workers the least tend to have higher turnover, which leads to a workforce with less experience in how to handle these difficult cases. That’s especially true for counties that are also geographically isolated.
One of the most extreme examples is Cherokee County, the westernmost county in the state. On the border of Georgia and Tennessee, Cherokee County is more than five hours from the state capital in Raleigh.
The county’s remoteness is a problem when it comes to training social workers. During a federal civil trial last month, former social workers said they trained in classes for a month before starting work at Cherokee County DSS. Some of those classes were held in Asheville, a two-hour, one-way drive from the workers’ headquarters in Murphy.
In 2009, at the height of the last recession, DHHS officials had concerns that social workers were not allowed to travel out of county to get required training.
Then in 2016, none of the 13 staff members, DHHS said, had completed all of the required training.
“Discussions revealed the lack of training and current policy knowledge is impacting compliance with NCDSS policy requirements,” a DHHS review of Cherokee County DSS in 2016 said.
That year, Cherokee County social workers increased their use of the illegitimate CVAs to separate parents and children.
Former social worker supervisor David Hughes testified in a May federal civil trial that only a couple of social workers could take training at once.
“Some (trainings) were offered one to two times per year,” Hughes said. “It might take three, four, five years to get those trainings in. While I was supervisor, we were short-staffed all the time.”
At times he supervised seven social workers, when state guidelines said he should at most supervise five. At other times, the county struggled to recruit and retain enough social workers.
“A lot of the time when I was supervisor, we might not have had five social workers,” Hughes said.
Within an 18-month period, Hughes testified, eight social workers left. He attributed the high turnover to a stressful job with low pay that also had on-call responsibilities.
“We lost social workers on a regular basis to other counties because the other counties pay more,” Hughes testified.
The high turnover rate in smaller, “typically rural and lower-resourced counties” diminishes productivity in departments, creates inconsistencies and puts children at risk, according to the 2019 Child Welfare Reform Plan.
A 2018 report by the state’s Office of State Budget and Management, along with DHHS, showed significant salary discrepancies among the state’s counties. Of the 100 counties, 51 responded to a survey with usable data asking questions about salaries.
“These have several negative impacts on service delivery, thus making consistent service delivery statewide problematic,” the report states. “Second, state salaries are too low to attract and retain quality candidates.”
Workers with insufficient experience and training may be more likely to make mistakes or fail to recognize when they are given improper instructions by supervisors.
For instance, using the wrong billing codes for child welfare services — accidentally or not — can lead to problems. Cherokee County and the state of North Carolina had to repay nearly $250,000 in federal foster care funds due to incorrect codes used by social workers three years ago. Certain services are paid for with different pots of money — local, state or federal.
In federal court last month, Hughes testified that either the DSS director or business officer would tell social workers which codes to use when billing for services. “Toward the end of the month they might say, ‘We are through this pot of money — you need to use this code now,’” Hughes testified.
However, code use, under federal law, is supposed to be determined by the nature of the expenditure and not by temporary financial necessity.
Some counties face greater challenges
After a social worker intervenes, families may make their way into the court system for a determination about where a child should be placed. Indigent parents are entitled to a court-appointed lawyer to represent them in district courtrooms for DSS court. Sylva-based attorney David Moore, who represents DSS agencies in Clay and Macon counties, said DSS court in the seven western counties is in session a couple of times a month.
If a case is continued, it may take weeks or months longer to resolve, leaving families in limbo and creating instability for children.
Records from the Administrative Offices of the Court show fewer than three dozen attorneys represented parents in Cherokee, Clay, Graham, Haywood, Jackson, Macon and Swain counties last fiscal year.
Court delays and a lack of available parent attorneys is a complaint voiced loudly by Cherokee County’s commissioners, who voted earlier this year not to sign a memorandum of understanding from DHHS that outlines expectations for DSS offices statewide. The rest of the state’s 100 county DSS offices have signed the agreement, according to records from DHHS.
In its letter to the state, the county’s five commissioners said court delays, many of which are out of the county’s control, are directly tied to the foster care costs.
“Additionally, the actual costs to the county for unnecessary long-term foster care are exorbitant,” the letter reads.
“The county share for children in foster care (at the state level of reimbursement) is approximately 50%. … The lack of oversight and attention to these issues cause DSS custody cases to be static without movement towards discharge to any permanent plan pushing performance measures for permanency further and further outside the federal measures.”
State legislation passed in 2017 requires DHHS to enter into these agreements, called Memoranda of Understanding, or MOUs, which outline the responsibilities of the county and the state for all social services programs, not just child welfare.
The 10-page agreement says all workers will “complete all required and necessary training” and departments are to follow state and federal laws. DHHS says it can also withhold state or federal funds for counties that fail to comply with the MOU or do not meet performance requirements.
However, DHHS granted a reprieve from consequences for failing to adhere to the MOUs in May 2020 due to the COVID-19 pandemic. “The decision was made to not issue formal corrective actions relating to MOU performance during (state fiscal year) 2019-2020,” a letter to all DSS directors read.
Moore, the attorney from Western North Carolina, said western counties also do not have enough resources to help parents and children who need help.
“Our mental health system is in shambles and has been since it was decentralized 20 years ago,” Moore said.
Many family separations he sees in court stem from poor mental health, which can lead to substance abuse. Harder drugs are taking hold in the west as well.
“Depending on what county you are in, it’s been methamphetamines, it’s been opiates. It may be fentanyl,” Moore said. “They are almost invariably tied with long-term mental health problems for the parents or the caretakers, and we don’t have adequate resources.”
Once a child is taken from his or her parents, DSS agencies may require parenting classes. Moore said the classes are often too far away, or they are “hit or miss.”
“Some of them, they charge the parent (money) every time,” Moore said. “You’re already talking about basically an indigent population, and you’re trying to charge them.
By contrast, Wake County, near the state’s center, has an entire team of social workers who are dedicated to parent education.
“We are able to provide free of charge a parenting group as well as one-on-one parenting coaching,” said Rosemond of Wake County.
“We assign parent coaches to the individual parents; we have a fatherhood team as well so that we can assign male social workers to fathers.”
Parenting plans agreed upon with social workers and the court often require that parents get jobs to pay for their housing and get driver’s licenses so they can get to work. Jobs exist in the west, but many of the jobs available do not pay enough to support families.
“They’re in this endless cycle,” Moore said of parents.
“They don’t have a driver’s license, because 10 years ago, they got a DWI and their license was suspended. And then they got multiple (tickets for driving with a revoked license).
“And the fines that have accrued, you know, they get thousands of dollars worth of fines, but they can’t pay them to get their license reinstated. It is this endless cycle of lack of resources that parents and families don’t have access to.”
Editor’s note: This is part 3 of the four-part investigative series “Patchwork Protection.” Part 1 appeared June 7 and part 2 on June 8. The final article in this series will examine potential solutions to some of the problems that the series has explored. This project was produced for the USC Annenberg Center for Health Journalism’s 2020 Data Fellowship.