1. Investigating Systemic Issues within the Colorado Child Protection System
The Colorado Children’s Caucus
April 9, 2018
Stephanie Villafuerte
Child Protection Ombudsman

2. Office of Colorado’s Child Protection Ombudsman (CPO)
Established in 2010 in C.R.S to 110
Independent state agency
Statutory Charge:
Create a well-publicized, easily accessible, transparent grievance process
Investigate public complaints regarding the child protection system
Improve accountability and transparency in the child protection system by providing information for system improvement

3. CPO Investigations The CPO is charged with:
Receiving and Investigating “complaints concerning child protection services made by or on behalf of any child relating to any action, inaction, or decision of any public agency or any provider that receives public moneys that may adversely affect the safety, permanency, or well being of the child.” (See C.R.S (1)(a)(I)(A))
Recommending “statutory, budgetary, regulatory, and administrative changes, including systemic changes, to improve the safety of and promote better outcomes for children and families receiving child protection services in Colorado.” (See C.R.S (2)(e))

4. CPO Investigations Every CPO investigation may involve:
An independent collection and review of information, records and documents, including child welfare histories, law enforcement records and court filings.
Staff visiting facilities or agencies to conduct interviews, and discuss policies and practices with agencies and providers.
Completing a written report summarizing the investigation and any recommendations, if applicable, for improvements.

5. CPO Investigations
Individual Citizen Investigations vs. Systemic Investigations
Individual Citizen Investigations:
Review and study a citizen’s interactions with an agency or provider within the child protection system.
Seeks resolution for any issues affecting the delivery of services to the individual child or family involved in the complaint.
Systemic Investigations:
Review and study a system or entity charged with delivering services to Colorado children within the child protection system.
May involve analysis of multiple agencies and providers.
Seeks to develop systemic recommendations that will improve the delivery of services to multiple children and families.

6. Increasing Demand for CPO Systemic Investigations
The CPO has seen an increase in requests by stakeholders to open systemic investigations, including:
The determination and award of adoption assistance across Colorado.
The oversight and regulation of residential child care facilities in Colorado.
The ability of children with intellectual and developmental disabilities to access adequate services in Colorado.
Ensuring juveniles within the Division of Youth Services receive proper medical care.

7. Meeting the Need for Systemic Investigations
To meet the demand and need for systemic investigations the CPO is:
Expanding the expertise of its staff.
Improving how the agency utilizes its internal data to help identify systemic trends and issues faster.
Improving communication with stakeholders for more efficient investigations and faster identification of issues.
Assessing how to streamline communication of ongoing and completed investigations to the General Assembly, citizens and stakeholders.

8. How Systemic Investigations Help Improve the Child Protection System
Engagement with multiple stakeholders helps form attainable and impactful recommendations for improvement.
System-wide recommendations improve the delivery of services for multiple children within the child protection system.
The CPO’s analysis and recommendations provide stakeholders and the General Assembly with objective insight regarding issues and possible improvements.

9. Colorado Adoption Assistance Program CPO Investigation, Case 2016-2074
Case opened on August 26, 2016
The CPO completed a 16-month investigation of the adoption assistance program prior to releasing its investigation report on December 13, 2017.
Allegations:
Disparities in statewide adoption subsidy monthly payments
Inconsistency in the administration of the program
Methodology and Scope of the CPO Investigation:
Surveys and/or interviews with 59 county child welfare directors
Interviews of two dozen adoptive families
Interviews of adoption community stakeholders
Review of state fiscal data (2014 through 2016)
Review of federal law as well as state law and regulations

10. Colorado Adoption Assistance Program CPO Investigation, Case 2016-2074
The CPO issued 14 recommendations
Recommendations were issued to the Colorado General Assembly, Colorado Department of Human Services (CDHS) and the Colorado Department of Health Care Policy and Financing (HCPF).
Recommendations addressed four areas of the program:
Legal Framework
Operating Structure
Funding
Post-adoption Services for Families and Children

11. Colorado’s Adoption Assistance Program
1980 Federal Adoption Assistance and Child Welfare Act.
Adoption subsidy was designed to incentivize the adoption of children from foster care who would otherwise languish in the system.
Funded by federal, state and local funds.
Administered on the local level by 59 county human services departments.
The CDHS distributes the majority of funds and supervises county departments’ programs.

12. Types of Benefits and Services Available
Monthly subsidy payments
Also called “cash assistance.” These payments are distributed by the county department.
Case Services
Medical services not otherwise covered by Medicaid or the monthly subsidy payment.
Examples include, unique eye glasses, medical equipment or orthodontia.
Non-Recurring Adoption Expenses
One-time payments made to adoptive parents to cover adoption fees (such as home study and court costs, birth certificate fees and transportation expenses) and legal fees.
Medicaid
Families are given access to services available under Medicaid, including physical and mental health therapies.

13. Area One: Legal Framework
Adoption assistance program is guided by three bodies of law; Federal law, Colorado law and state regulations (Volume VII).
CPO Findings:
1) Colorado laws and regulations do not accurately reflect federal legal requirements.
2) Outdated laws have resulted in inconsistent interpretation by county departments.
3) Different legal standards are used throughout the state to determine what services and subsidies are provided to children.
Recommendation: Revise Colorado law to provide clear guidance to agencies administering the program to ensure fair consideration for subsidies and services available under the program.

14. Area Two: Operating Structure
Colorado’s adoption assistance program is administered by 59 county departments, each with a different set of policies for the program.
CPO Findings (5):
1) Inconsistent policy and practice among 59 county departments.
2) Inconsistency in the assessment of a child’s needs and the determination of subsidies.
3) Lack of meaningful program evaluation and support.
4) Lack of training and support for workers who administer the benefit.
5) Inadequate and inconsistent information being provided to adoptive families.

15. Area Two: Operating Structure (Continued)
CPO Recommendations:
1) Develop uniformity in program definitions, available services and in negotiation practices.
2) Determine a common methodology that ensures children and families needs are being assessed similarly and that the subsidy amounts support the long-term well-being of children and stability of adoptive children.
3) Deepen substantive evaluations and include experience of adoptive families.
4) Develop training curriculum for caseworkers to understand the laws and rules guiding adoption subsidies and provide adoption informed training to ensure families/children receive services appropriate for their needs.
5) Create standardized state-wide forms; an accessible website portal regarding the adoption assistance program including eligibility requirements, details about benefits and services available and legal standards and requirements.

16. Area Three: Funding CPO Findings (3): CPO Recommendation:
Funding formula is insufficient and does not account for the long-term and expansive needs for children.
No separate line item for adoption subsidies/services. Currently, benefits are administered within a child welfare budget which must fund other child protection services.
Total adoption expenditures (subsidies, case services, non-recurring fees) are not tracked.
CPO Recommendation:
Study alternative methods of funding the adoption assistance program to decrease the variance of subsidy benefits and enhance counties ability to support adoptive children and their families.

17. Area Four: Post-Adoptive Services
CPO Findings (2):
There are minimal centralized, statewide resources for families seeking post-adoption services.
Families struggle to access adoption informed behavioral health providers who accept Medicaid.
CPO Recommendations:
1) CDHS create a statewide inventory of adoption-informed resources to help connect families with post-adoption resources in every part of the state.
2) CDHS to work with the HCPF to identify barriers and obstacles that prevent adoptive families from obtaining adoption competent services.
3) Study the rate at which adoptive children are accessing Medicaid services after finalizing their adoption.
4) Study what services are being supplied by Medicaid providers to adoptive children and whether these services are meeting their needs.
5) Implement a public reporting requirement.

18. Impact of CPO Investigation
Senate Bill :
Will effectively bring Colorado’s statute regarding adoption assistance in-line with federal law and guidance, providing a strong foundation for the program to move forward.
Funding Reform:
Using analysis provide by the CPO and the investigation report, Joint Budget Committee staff have drafted legislation which includes changing mechanisms for how the program is funded in Colorado.
CDHS Efforts:
The Colorado Department of Human Services has initiated efforts to study various areas of the program.

19. Stephanie Villafuerte, Ombudsman
Thank You
Stephanie Villafuerte, Ombudsman