Times Observer photo by Stacey Gross Members of Forest-Warren Human Services and other agencies met Friday to determine their strategy for a three-year progress.

Children and Youth Services in Warren County is doing well.

According to the results of the three-year quality service review, conducted by the Pennsylvania Department of Human Services Office of Children, Youth, and Families, Warren County’s CYS is falling in the high end of most of the indicators evaluated.

The process involves a random sampling of open CYS cases by independent reviewers appointed by the state, and evaluates each case on a number of “indicators” on a scale of one, adverse status, to six, optimal status.

Any scores in the one-to-three range are graded unacceptable and any in the four-to-six range are graded acceptable. The percentage of cases rated acceptable and unacceptable in the sampling is calculated for each indicator.

For this round’s evaluation, a total of seven cases were sampled, out of a total 186 cases open at the time of evaluation, with four of those cases being families whose children are in the home and three of them being families whose children are in out-of-home placement.

Five of the children whose cases were part of the review were male, and two were female.

Three were between the age of zero to one, one was between the ages of six to nine, one was between the ages of 10 to 12, and two were between the ages of 16 to 17.

Reasons for each of the cases to be open were physical abuse (1), sexual abuse (1), emotional maltreatment (1), mental or physical health issues for parents (1), substance abuse by the child (1), child’s behavior (2), domestic violence in the home (1), child in the juvenile justice system (2), and other (4).

Of the cases reviewed, four families had goals of having the children remain in the home, one had a goal of having the child return to the home, and two had a stated goal of adoption.

Of the seven cases evaluated, three had children living at home with their biological mothers, one had the child living at home with both biological parents, one was in a formal kinship foster home, and two were in traditional foster homes.

The status indicators — variables measured in the review — measure the extent to which certain desired conditions relevant to safety, permanence, and well-being are present in the life of the child and the parents or caregivers. Status indicators for family variables generally focus on the most recent 30-day period prior to the date of the on-site review.

The first family status indicator — safety — was broken down into two sub-indicators. In the “exposure to harm” sub-indicator, measuring a child’s freedom from abuse, neglect, and exploitation, the score was 82 percent acceptable (down from the 2015 score of 94).

For the second sub-indicator, “risk to self and others,” assessing the degree to which the child avoids self-endangerment and refrains from using behaviors that may put others at risk of harm, the rating was 75 percent acceptable (down from the 2015 score of 83).

Indicator two, “stability,” measures the degree to which the child’s daily living and learning arrangements are stable and free from risk of disruptions. That rating was 82 percent acceptable (up from the 2015 score of 38).

For indicator three, “living arrangement,” which assesses the degree to which children are living in the most appropriate and least restrictive environment, the rating was 100 percent acceptable (up from 80 percent).

For indicator four, “permanency,” which assesses the degree to which children, parents, caregivers, and other team members can safely assume that current caregivers will continue to fill that role until the child reaches adulthood, the rating was 86 percent acceptable (up from 43).

For indicator five, “physical health,” which assesses the degree to which children are achieving and maintaining optimum health status, the rating was 86 percent acceptable (the same as 2015).

For indicator six, “emotional well-being,” which assesses the degree to which children display adequate attachment patterns, social relationships, and coping skills, the rating was 86 percent acceptable (the same as 2015).

Indicator seven was broken down into two sub-indicators. The first, “early learning and development,” which measures the degree to which a child’s development is commensurate with age and developmental expectations, the rating was 100 percent acceptable (the same as 2015). For the second sub-indicator, “academic status,” which measures the degree to which children are attending and succeeding in school, the acceptable rating was 75 percent (down from 80).

For indicator eight, “pathway to independence,” which measures the degree to which youth are gaining skills in independent living commensurate with age, the rating was 50 percent acceptable (up from zero).

For indicator nine, “parent and caregiver functioning,” which assesses the degree to which adults responsible for caring for children are will and able to provide them with physical and emotional support and security, the acceptable rating was 54 percent (up from 44).

Indicators for agency performance are also evaluated, and measure the extent to which best practice guidelines are applied successfully by members of the team serving the family. These indicators generally identify the quality of work being done within the most recent 90-day period prior to the on-site review.

The first indicator was broken down into two sub-indicators. The first, “engagement efforts,” focuses on diligence shown by service teams in taking actions to find, engage, and build rapport with families to overcome barriers to that family’s success. The rating for the first sub-indicator was 85 percent acceptable (up from 62). The second sub-indicator, “role and voice,” assesses the degree to which families and caregivers are active participants in shaping decisions made about their own needs, goals, and services. That indicator was rated at 90 percent acceptable (up from 64).

Indicator two, “teaming,” measures the degree to which appropriate teams are both created and implemented for families with open cases. The rating for that indicator was 86 percent acceptable (up from 57).

For indicator three, “cultural awareness and responsiveness,” which assesses the degree to which relevant cultural issues, family beliefs, and customs are identified and addressed, the rating was 94 percent acceptable (down from 100).

For indicator four, “assessment and understanding,” which measures the degree to which the team has gathered and shared essential information with family members, the rating was 95 percent acceptable (up from 71).

For indicator five, “long-term view,” which focuses on making positive changes made during an open case sustainable after the case closes, the rating was 71 percent acceptable (up from 43).

For indicator six, “child youth and family planning process,” which assesses the degree to which the planning process is individualized to the family being served, the rating was 90 percent acceptable (up from 52).

For indicator seven, “planning for transitions and adjustments,” which assesses the degree to which transitions for families are being planned and prepared for, the rating was 80 percent acceptable (up from 57).

For indicator eight, “effort to timely permanence,” which seeks to establish that efforts to safely close cases are diligent and expeditious, the rating was 70 percent acceptable (up from 64).

For indicator nine, “intervention adequacy and resource intervention,” which measures the degree to which services are efficacious at meeting long-term family needs, the rating was 93 percent acceptable (up from 71). For indicator ten, “maintaining family relationships,” which assesses the degree to which interventions are building and maintaining positive interactions with families, the rating was 60 percent acceptable (down from 89). And for indicator 11, “tracking and adjustment,” which seeks to evaluate how well progress toward goals are monitored and how well adjustments to goals are made given the dynamic situation for the family, the rating was 93 percent acceptable (up from 79).

The top three indicators in which Warren County’s CYS program is performing are “living arrangement,” “early learning and development,” and “assessment and understanding.”

The only indicators that were scored below 70 percent acceptable were “parent and caregiver functioning,” “pathway to independence,” and “maintaining family relationships.”

“These numbers are not bad numbers,” said Practice Improvement Specialist Stephen Eidson, who works on QSRs across the state. The other thing to remember, he said, is that the QSR measures outcomes, not necessarily effort.

Certain indicators — parent and family engagement and mental health, for instance — there’s only so much that an agency can do. It’s rare, said Eidson, to have only three indicators below 70 percent.

“You should be pleased and congratulated for that,” he told providers at the review Friday afternoon.

After reviewing the results of this year’s QSR, CYS Quality Assurance Supervisor Kimberly Carlson said that the agency would be meeting regularly over the next three years — the amount of time between QSRs in Pennsylvania — to identify areas to focus on improving and strategize ways to do that. Among the initial ideas presented by those providers present during the review were to focus on the indicators of pathways to independence/planning for transition, and caregiver functioning. Ideas for improving those areas were to work on getting those youth with cases open who are living in their homes access to independent living training, and developing ways to build rapport with families as a way to incentivize making needed changes.

The agency’s biggest improvement and strength at this time, said Carlson, is the effort it’s made to increase the amount of self-efficacy families with open cases feel by taking part in family team planning, identifying their own goals and working toward their own path to success.

Updates to the agency’s efforts to improve the indicators they selected to focus on during this round will be forthcoming to the public.