Missouri Department of Social Services Childrens Division Critical

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Missouri Department of Social Services Children’s Division Critical Events Process and Too ls

Missouri Department of Social Services Children’s Division Critical Events Process and Too ls

Fatality/Critical Event Reporting and Review Protocol The Agency’s Response to Critical Events. q Reporting

Fatality/Critical Event Reporting and Review Protocol The Agency’s Response to Critical Events. q Reporting q Reviewing q Documenting

Purpose • The purpose of this process is to review circumstances surrounding critical events,

Purpose • The purpose of this process is to review circumstances surrounding critical events, including the Children’s Division’s initial response to the critical event and prior involvement with the impacted family. • The goal is to identify systemic issues, agency practices, or areas of need which, if addressed through policy or practice, may improve the Division’s effectiveness moving forward.

What Are Critical Events? Critical Events Fatality Near Fatality Suicide Serious Physical Injury

What Are Critical Events? Critical Events Fatality Near Fatality Suicide Serious Physical Injury

What Other Events require a Critical Event Response? Other Events Requiring Response Media Attention

What Other Events require a Critical Event Response? Other Events Requiring Response Media Attention Child in Foster Care Involving Sexual Abuse or Assault Human Trafficking

What is a Critical Event Report (CS-23)? The CS-23 provides staff a method for

What is a Critical Event Report (CS-23)? The CS-23 provides staff a method for collecting accurate, consistent information quickly in order to notify CD Administration of critical events or other situations that require a critical event response.

Critical Event Categories Critical events are classified by category, which determines the Division’s response.

Critical Event Categories Critical events are classified by category, which determines the Division’s response. Categories include: q Category A q Category B q Category C q Category D q Category E

Category A Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N with

Category A Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N with relevant CD involvement

Category B Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N or

Category B Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N or non. CA/N involving a child with an open FCS case, IIS case or pending hotline.

Category C Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N or

Category C Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N or non-CA/N and involves foster child.

Category D Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N with

Category D Fatality, near fatality, suicide or serious injury Resulting from alleged CA/N with no relevant CD involvement.

Category E - OTHER… Other events considered serious which meet one of the following:

Category E - OTHER… Other events considered serious which meet one of the following: q Media attention - has occurred or is likely to occur q Child in foster care - involving sexual abuse, exploitation or assault q Human trafficking - Reported allegations.

Definitions for “Critical Events” Category A, B, C, and D

Definitions for “Critical Events” Category A, B, C, and D

Serious Physical Injury An injury which creates a substantial risk of death or causes

Serious Physical Injury An injury which creates a substantial risk of death or causes serious permanent disfigurement or protracted loss or impairment of the function of any bodily member or organ. [See (42 USCS § 247 d-6 d (10)]

 Relevant History The term “relevant history” referenced in this policy refers to prior

Relevant History The term “relevant history” referenced in this policy refers to prior CA/N or prior open cases which involve similar incidents or allegations of CA/N; or imply a general history of abusive or neglectful behavior related to the current event.

Near Fatality “An act that, as certified by a physician, places the child in

Near Fatality “An act that, as certified by a physician, places the child in serious or critical condition. " For example: If hospital records reflect the child's condition is serious or critical, this would be considered a near fatality. [See (Child Abuse Prevention and Treatment Act (CAPTA), as amended (42 U. S. C. 5101 et seq. ) - sections 106(b)(2)(B)(x) and (b)(4(A)]

Definitions for “Other” Events Category E

Definitions for “Other” Events Category E

Media Attention Refers to a critical event that has been or is likely to

Media Attention Refers to a critical event that has been or is likely to be covered or referred to by news media, which may include print media (newspapers, magazines), broadcast news (radio, television), or the Internet (online newspapers, news blogs, etc. ).

The term " sexual abuse " includes: q the employment, use, persuasion, inducement, enticement,

The term " sexual abuse " includes: q the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or q the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children. [See Child Abuse Prevention and Treatment Act (CAPTA), Section 111. [42 U. S. C. 5106 g]

Sexual Assault Includes the following: q The acts of rape, forcible rape, statutory rape

Sexual Assault Includes the following: q The acts of rape, forcible rape, statutory rape (1 st and 2 nd degree), sexual assault, sodomy, forcible sodomy, statutory sodomy (1 st and 2 nd degree), child molestation (1 st and 2 nd degree), deviate sexual assault, sexual misconduct and sexual abuse, or attempts to commit any of the aforesaid; and q The act of enticement of a child or any attempt to commit such act. (See Chapter 566 RSMo. Sexual Offenses)

Sexual Assault (continued) Includes incest, the act of abuse of a child involving sexual

Sexual Assault (continued) Includes incest, the act of abuse of a child involving sexual contact, and the act of use of a child in a sexual performance. (See Chapter 568 RSMo. Crimes against Persons)

 Human Trafficking Involves a victim of any of the following offenses: q Abuse

Human Trafficking Involves a victim of any of the following offenses: q Abuse through forced labor q Trafficking for the purpose of slavery, involuntary servitude, peonage, or forced labor q Sexual trafficking of a child or for the purposes of sexual exploitation (See Sections 566. 200, 566. 203, 566. 206, 566. 209, 566. 212, or 566. 213 RSMo. )

CS-23 Time Frames When a CRITICAL EVENT or CRITICAL EVENT OTHER event OTHER requiring

CS-23 Time Frames When a CRITICAL EVENT or CRITICAL EVENT OTHER event OTHER requiring response occurs: 1. The supervisor will notify appropriate management/regional staff ; 2. Management/regional staff will ensure CD Director/Designee is notified immediately; 3. Supervisor will review and submit a CS-23 to Central Office and CC the Circuit Manager and Regional Director via email at: DSS. CD. Critical. Event. Report@dss. mo. gov If unable to access email, fax CS-23 form to: 573 -526 -3971

Initiate CS-23 Categories A, B or C Business hours - within 3 hours After

Initiate CS-23 Categories A, B or C Business hours - within 3 hours After hours - by 10 a. m. the following business day Category D or E Within one business day, unless media involved (refer to A, B, C timeframes)

CS-23 Procedure q Complete the CS-23; q Conduct CA/N system check on all persons

CS-23 Procedure q Complete the CS-23; q Conduct CA/N system check on all persons associated with the event; q Include available information from other counties or states; and q Send updated CS-23 to Central Office as new/pertinent information becomes available.

Critical Event Tool Kit A collection of tools used to guide a critical event

Critical Event Tool Kit A collection of tools used to guide a critical event reviewer through the case review process in response to critical events.

Who completes the reviews? Category A and B Reviewer internal to the region of

Who completes the reviews? Category A and B Reviewer internal to the region of the critical event Category C Reviewer external to the region of the critical event Division Director/designee has the discretion to request a review by another region.

When is a Critical Event Tool Kit Required? Every critical event requires completion of

When is a Critical Event Tool Kit Required? Every critical event requires completion of a CS-23, however; not every CS-23 requires a Critical Event Tool Kit.

When is a Critical Event Tool Kit Required? q Category A - A Critical

When is a Critical Event Tool Kit Required? q Category A - A Critical Event Tool Kit is required. q Category B – A Critical Event Tool Kit is only required if CA/N is suspected or a review panel is requested by the Division Director/Designee. q Category C – Critical Event Tool Kit is required. q Category D and E, a Critical Event Tool Kit is not required, unless requested by the Regional Director or Central Office.

Critical Event Tool Kit q Case Review of the Critical Event q Log of

Critical Event Tool Kit q Case Review of the Critical Event q Log of Prior History (CA/N, AC, FCS and IIS) q Review of Open cases q Review of Priors q Staff Interviews q Observations from Critical Event Review

Case Review of the Critical Event CD-164 RF OR Used to review Critical Event

Case Review of the Critical Event CD-164 RF OR Used to review Critical Event Cases which occurred in a family home Used to review Critical Event cases which occurred in a resource home

Log of Prior History CD-164 A Used to log all prior history including CA/N

Log of Prior History CD-164 A Used to log all prior history including CA/N history and current open or closed AC, FCS or IIS cases

Review of Open Cases CD-164 FCS CD-164 AC Used to review open FCS cases

Review of Open Cases CD-164 FCS CD-164 AC Used to review open FCS cases Used to review open AC cases CD-164 IIS Used to review open IIS cases

Review of Prior History CD-164 CAN_P CD-164 FCS_P Used to review CA/N history relevant

Review of Prior History CD-164 CAN_P CD-164 FCS_P Used to review CA/N history relevant to the current Critical Event Used to review FCS history relevant to the current Critical Event CD-164 AC_P CD-164 IIS_P Used to review AC history relevant to the current Critical Event Used to review IIS history relevant to the current Critical Event

Staff Interviews CD-164 B Used to conduct interviews with staff connected to the current

Staff Interviews CD-164 B Used to conduct interviews with staff connected to the current event, open case or prior cases (relevant to current critical event)

Observations from Critical Event Review CD-164 C q The reviewer will summarize findings from

Observations from Critical Event Review CD-164 C q The reviewer will summarize findings from all case records reviewed and interviews noting any practice concerns or practice trends. q Recommendations may include issues related to law, policy, practice and training.

Tool Kit Completion: Complete within 10 business days and submit to: DSS. CD. Critical.

Tool Kit Completion: Complete within 10 business days and submit to: DSS. CD. Critical. Event. Report@dss. mo. gov Carbon copy Regional Director.

Critical Event Review Panel q A multi-disciplinary panel designed to bring insight from outside

Critical Event Review Panel q A multi-disciplinary panel designed to bring insight from outside the Division q The goal is to look at agency systems and causal factors which may have impacted the event

Critical Event Review Panel meetings are held for: q All Category C events if

Critical Event Review Panel meetings are held for: q All Category C events if CA/N is suspected or if requested by the Division Director/Designee q Category B fatalities if CA/N is suspected or if requested by the Division Director/Designee q Categories A, B (non-fatalities), D and E, only if requested by the Division Director/Designee

Critical Event Review Panel The reviewer and staff from the incident county present an

Critical Event Review Panel The reviewer and staff from the incident county present an overview of the incident, comment on the findings, and provide case updates.

Who Typically Attends? q q q The Reviewer Division Director and Regional Director Contracted

Who Typically Attends? q q q The Reviewer Division Director and Regional Director Contracted Case Management CEO or designee Representation from: q q q Children’s Division Central Office (CD) Department of Social Services (DSS) Division of Youth Services (DYS) Department of Mental Health (DMH) Division of Legal Services (DLS) State Technical Assistance Team (STAT)

Trends and Action Steps q At each Executive Team meeting, critical events and trends

Trends and Action Steps q At each Executive Team meeting, critical events and trends will be discussed for law, policy, practice and training implications statewide. q Regional Directors will discuss findings and address appropriate plans of action within their regions.

The End

The End