Improving Outcomes for Children
Philadelphia Department of Human Services
United States

The Problem

In 2006, Philadelphia’s child welfare system was in dire crisis. Danieal Kelly, a 14-year old girl with cerebral palsy, died of neglect. She was severely emaciated, weighing only 46 pounds, and was covered in bedsores. Four years earlier, Danieal had been placed in the care of Philadelphia’s Department of Human Services (DHS) – the municipal agency charged with protecting children at risk for abuse and neglect.

At the time of Danieal’s death, DHS was providing in-home services to approximately 6100 children at risk for abuse and neglect and monitoring the care of approximately 6,000 in dependent out-of-home placement. It also provided a myriad of services for thousands of children at risk of child-welfare involvement. The vast majority of children and families served were low-income, racial and ethnic minorities.

In the fall of 2006, The Philadelphia Inquirer published a series of articles documenting DHS’ unmitigated failure to protect the children in its care. The articles described the egregious conditions under which some children died while in the agency’s care and decried the DHS’ overall lack of accountability. Among the problems underscored was the overlap and a lack of clarity in the roles of social workers employed by DHS and its contracted agencies, which created an environment where children like Danieal could fall through the cracks.

Danieal’s death and subsequent media scrutiny led to the near collapse of the Department. The Commissioner and her top staff were fired by the Mayor. Two DHS social workers and staff from DHS provider agencies were criminally charged and convicted for their part in Danieal’s death. Agency credibility and staff morale hit rock bottom.

In response to public outcry about DHS’ failures, Mayor John Street issued an Executive Order establishing the Child Welfare Review Panel (CWRP). Comprised of nine nationally-recognized child welfare experts, the CWRP was charged with conducting a comprehensive review of DHS’ strengths and weaknesses and developing recommendations for improvement.

In its assessment of DHS’ operations and capacity the CWRP noted: lack of clarity of mission and purpose permeated the agency as a whole as well as its individual programs; the relationship between DHS and its contracted agencies was characterized by a process orientation which has not required results for children and families; mechanisms for accountability were weak at the direct service, managerial, and inter-organizational levels; and workers and supervisors were not held to a clear standard of practice.

In summary, the CWRP noted “The children in DHS’ care are among the most vulnerable citizens in Philadelphia. DHS interacts with these children during critical times in their lives, when the highest degree of commitment, professionalism, and care is needed. These children cannot defend or care for themselves, and it is clear that DHS frequently has not risen to the challenge to protect these children.”

The CWRP’s report, entitled A Call to Action, included no fewer than 37 recommendations for reform. These recommendations called for sweeping changes in every aspect of the agency including mission and core values, decision making, policy and practice; and accountability.

Solution and Key Benefits

 What is the initiative about? (the solution)
Over the past six years, DHS has undergone a complete transformation. The agency has instituted comprehensive organizational and structural reforms and implemented almost all of the CWRP’s
recommendations, resulting in increased accountability, improved processes and most importantly, significantly enhanced child safety and well being. The foundation of these reforms was the adoption of a safety model of practice, which informs every aspect of the Department’s work with children from intake to case closure.

To measure its success and increase overall accountability, the Department established the Division of Performance Management and Accountability (PMA), which monitors and evaluates both agency and provider performance utilizing data-driven tools. PMA also works to improve practice by reviewing cases from across the system to examine the quality and consistency of safety assessments and service plans and recommend improvements. Since 2009, PMA has conducted over 4500 case file reviews.

Based on data collected and analyzed by PMA, we know that children served by DHS today are more closely monitored for safety issues. The safety model of practice enables the agency to better identify and focus its resources on those children at greatest risk of abuse and neglect. As a result, the number of children in dependent placement decreased 32% between 2006 and 2011. During the same time period, DHS reduced out-of-state dependent placements 56% and out-of-state delinquent placements 96% enabling social workers to more effectively monitor child safety and children to maintain contact with their biological families as appropriate. To further ensure the safety of children, in 2010 DHS implemented a protocol requiring workers to visit children in placement at least once a month. The Department has maintained over 90% compliance since the protocol was established.

DHS has also increased the timely permanency of children in its care. Since 2007, children discharged to permanent homes increased from 23% to 26%. The average number of months in care decreased from 21.2 to 18.8. The agency implemented several innovative measures to increase permanency and stability and ensure that all youth in care have connections to caring adults. For example, the Family Finding program identifies and locates family members who may be able to serve as resources for youth in care. This program has connected children to relatives they previously did not know they had. Today, approximately 44% of children in foster care live with kin.

DHS also addressed overlap in worker roles that allowed some children to fall through the cracks. The agency recently overhauled its service delivery model, launching a groundbreaking new initiative called Improving Outcomes for Children’ (IOC). Recognizing that positive outcomes are achieved through child welfare services that are family-centered, community-based, culturally competent, integrated, timely, and accountable for results, IOC is a community-based model, with distinct and well-defined roles for both DHS and provider agencies. This model improves accountability by streamlining the responsibility for service delivery to a single neighborhood-based provider agency and ensures children have a single case manager through the life of their case.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
DHS’ reform effort was a collaborative and inclusive
undertaking. At every step, the agency drew upon the collective expertise of a wide range of local and national stakeholders. Key contributors include:

The Child Welfare Review Panel (CWRP): Established by former Mayor John Street and comprised of nine nationally-recognized experts, the CWRP developed a report highlighting the agency’s weaknesses and outlined 37 recommendations for reform. In developing these recommendations, which served as the genesis of the reform effort, the panel consulted with more than 800 individuals including DHS leadership and staff, management and staff at provider agencies, parents, teens aging out of the system, attorneys, judged and community representatives.

The Community Oversight Board (COB): Initially appointed by Mayor Street, and then reestablished by Mayor Michael Nutter upon his election, the COB is an independent, multidisciplinary panel of local and national experts responsible for assessing and monitoring the agency’s progress toward implementing the CWRP recommendations. The 13-member board serves as independent assessors, expert advisors, and community advocates.

Mayor Michael A. Nutter, DHS Commissioner Anne Marie Ambrose, DHS leadership and staff: Philadelphia Mayor Nutter has been an unwavering champion of the reform effort. One of his first acts as Mayor was to reestablish the COB. After an extensive national search, he appointed Anne Marie Ambrose to lead a comprehensive and sustained reform of the ailing organization, giving her his full support. Commissioner Ambrose, who has been a courageous leader, was widely welcomed by DHS staff and the community based on her dedication and experience as an advocate for youth in the juvenile justice system, first as an attorney for the Defender Association and later in city and state leadership positions related to improving the lives of at-risk youth. Under Commissioner Ambrose’s leadership, DHS staff at every level of the organization has implemented some of its most significant reforms, including a Safety Model of Practice and a redesign of the agency’s service delivery model.

Foundations: From the start, DHS has received invaluable support in the form of financial resources, professional expertise and technical assistance from Casey Family Programs, the nation’s largest operating foundation focused entirely on foster care and improving the child welfare system. Pew Charitable Trusts, the William Penn Foundation and the Annie E. Casey Foundation have also supported the reform effort and the oversight work of the COB.

In addition to these principal entities, more than 150 people and stakeholder groups throughout the city were actively engaged in developing the redesign of DHS’ service delivery model including representatives from the provider community, Family Court leadership, city officials, academics, advocates, union leaders, system partners (including the Department of Behavioral Health and Intellectual disAbilities and the Philadelphia School District as well as the District Attorney’s office), and of course youth and parents.. DHS drew upon the experience and best practices of child welfare agencies throughout the country, including the state of Florida and New York City, which have adopted similar models.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
The driving force of the reform effort was the implementation of a safety model of practice, which incorporates child safety into every aspect of decision making from intake to case closure.

A key component of the safety model is Hotline Guided Decision Making (HGDM), an evidence-based, standardized decision-making model for screening and investigating abuse and neglect. HGDM, which focuses on identifying issues that affect child safety, helps ensure that children and families receive the most appropriate services based on their needs. Other components of the safety model include the use of evidence-based standardized safety assessment tools and protocols which require workers to make face-to-face visits to children at least once a month. Additionally, to ensure the safety of medically fragile children in DHS care, the Department added a nursing unit to help social workers better understand, plan for and advocate for the needs of children and families with medical issues.

The agency also made a concentrated effort to engage the families of children its care through the implementation of Family Group Decision Making (FGDM), a family centered, culturally sensitive approach to decision making. FGDM empowers family members to collaborate with child welfare workers and other professionals in the development of strengths-based plan to promote safety, permanency and well being for the family.

Increasing DHS accountability was also critical to the reform effort. In 2009, Commissioner Ambrose created the Division of Performance Management and Accountability (PMA) to monitor agency performance and contribute to improved practice. PMA takes a multi-layered approach to quality improvement that includes: Monthly case file reviews as reported in question 2; Quality Service Reviews (QSR), which assess the quality of services and outcomes for randomly selected cases using a federally vetted standardized instrument; and ChildStat, which provides a forum for professionals of all disciplines involved in a child’s case to discuss outcomes data and performance measures. DHS also established an interdisciplinary team to review child fatalities and near fatalities, identify issues and develop recommendations for addressing concerns.

To increase agency transparency DHS made a concerted effort to communicate regularly with stakeholders and community members. The agency established and widely marketed the Commissioner’s Action Response Office (CARO), which handles complaints, concerns and suggestions. It also holds regular town hall meetings throughout the city to update community members on its reform efforts.

Finally the agency overhauled its entire service delivery model through the implementation of Improving Outcomes for Children (IOC). IOC is a community-based model of service delivery, with distinct and well-defined roles for both DHS and provider agencies. With this approach services are delivered by trusted neighborhood providers while DHS provides monitoring, oversight and quality assurance. The model has a strong focus on Family Teaming, which brings together the family and service and system partners at key decision points over the life of a case. IOC is expected to foster stronger partnerships at the neighborhood level; facilitate the development of culturally relevant resources and services within the community; and improve quality assurance functions within DHS.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
The death of Danieal Kelly and subsequent media investigation into the failure of Philadelphia’s child welfare system led to the establishment of the Child Welfare Review Panel which developed a road map for rebuilding DHS.

In 2007, in response to the most pressing recommendations from the CWRP report, DHS implemented Hotline Guided Decision Making, which utilizes an evidence-based tool to assess the safety of children and ensure that families receive the most appropriate services based on identified threats to child safety. The agency also developed protocols to ensure every child in the system receives monthly face-to-face visits to monitor safety.

In January, 2008, newly elected Mayor Nutter reaffirmed the City’s commitment to the reform effort by reestablishing the Community Oversight Board, which monitors the progress of the reform effort. A few months later the Mayor appointed Anne Marie Ambrose as Commissioner of DHS, a proven leader who has dedicated her entire career to improving the lives of at-risk youth.

In 2009, DHS created the Division of Performance Management and Accountability (PMA) to monitor agency performance, measure outcomes and contribute to improved practice. One component of PMA, the DHS Act 33 Review Team, has served as a state model for effective interdisciplinary and interagency coordination in examining child fatalities and near fatalities and for identifying and monitoring the implementation of recommendations to improve child safety.

Also in 2009, Philadelphia launched two major initiatives to improve educational outcomes for children in care: a citywide truancy reduction plan predicated on a rigorous process of cross-system planning and collaboration and an Educational Support Center, which enhances the educational stability and academic progress of children and youth in care by providing child-specific educational consultations to resolve individual barriers.

To help improve outcomes for older high-needs youth in long-term placement, the agency launched Developing Connections, which aims to ensure that youth have the connections, sense of belonging and support they need to thrive. Since its inception in 2009, the number of youth aging out of care with a permanent home has more than doubled as has the number of youth with an active connection. Additionally, the number of youth with a source of income has increased by more than half.

In 2011 DHS introduced Electronic Case Management System, a paperless system that increases efficiency by reducing redundancies and improving the accuracy of files. As a result, workers spend less time on paperwork and more time focusing on the children they serve.

Finally, this past year DHS launched Improving Outcomes for Children, which represents a complete overhaul of its service delivery model. The new model helps prevent vulnerable children like Danieal Kelly from falling through the cracks by outlining distinct, well-defined roles for DHS and provider agencies. It also ensures that children and families receive culturally competent services in the communities where they live from trusted providers. IOC is expected to foster stronger partnerships at the neighborhood level; facilitate the development of culturally relevant resources and services within the community; and improve quality assurance functions within DHS.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
The death of Daneial Kelly, which served as the catalyst for the overhaul of Philadelphia’s child welfare system, was followed by a period of intense media scrutiny and public distrust. During this time the Commissioner and her top staff were asked to resign, DHS social workers and provider staff were indicted for failing to prevent Daneial’s death (which was unprecedented), staff morale had plummeted and the agency’s credibility was at an all-time low. Moreover, even as DHS leadership tried to initiate changes in policy and practices that would begin to address systemic failures they were frequently thwarted by pushback from the union as well as staff who were resistant to change.

With the election of Mayor Michael Nutter, DHS took the first steps toward overcoming these obstacles. Within weeks of his election, the Mayor affirmed his commitment to the reform effort by reestablishing the Community Oversight Board, reassuring the public that the reform efforts would be closely monitored and guided by highly regarded child welfare experts. The Mayor’s subsequent appointment of Anne Marie Ambrose as the agency’s new Commissioner was also instrumental in helping to build trust among Department staff, provider agencies and other stakeholders

Ambrose’s laser-like focus on mission and vision energized staff, providers and other stakeholders. With the Mayor’s full support, she also had the political will to make bold decisions that were critical to ensuring the safety of children, such as terminating long-held contracts with ineffective providers. She worked to overcome resistance to change that had stalled earlier reform efforts by involving staff and union representatives in discussions about every aspect of reform. Ambrose also bolstered DHS staff and reduced agency reliance on consultants. She appointed a strong and dedicated leadership team; provided regular reform updates via electronic and print media; and supported the efforts of a staff morale committee.

However lack of accountability proved to be another major obstacle. The agency had no way to measure its reform efforts. In 2009, Commissioner Ambrose created a new agency division called Performance Management and Accountability (PMA) described in question 4a.

Increased transparency was also critical to restoring public confidence. A series of town hall meetings were held to update community members and other stakeholders about progress on the reform effort. DHS also established and marketed the Commissioner’s Action Response Office, which enables the public to provide input and voice concerns. Additionally, the regular release of reports by the COB--an independent panel of experts—documenting DHS’ progress also helped to increase the agency’s credibility.

Finally, throughout the reform effort DHS worked closely with the courts, under the Leadership of its Administrative Judge, to improve communication and develop a partnership focused on achieving better outcomes for children. This collaboration sparked innovative approaches to problems and a more effective utilization of resources resulting in improved safety and permanency for children involved in the system.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Perhaps what is most noteworthy about the reform of Philadelphia’s child welfare system is that it was accomplished with minimal additional financial resources. DHS, which has a needs-based funding structure, is supported by a combination of federal, state and city dollars. The launch of the reform effort coincided with the onset of the recession, which has affected public funding at every level. As a result, DHS has experienced a reduction of funding and has accomplished the majority of its reforms by redeploying existing resources.

When Anne Marie Ambrose assumed the role of Commissioner DHS was heavily reliant on consultants. By significantly reducing the number of consulting contracts and reassigning key functions to full-time DHS staff, the agency not only realized significant cost savings but also increased accountability. Other cost-effective strategies included identifying and eliminating duplication of effort and introducing efficiencies such as the utilization of electronic case notes, which reduces the amount of time social workers spend on paper work. In this manner, the agency was able to redirect available funding toward improving policies and practices that better ensure the safety and well being of vulnerable children.

Philadelphia has also been successful in attracting resources from National foundations. The Pew Charitable Trusts and the William Penn Foundation both provide funding to support the Community Oversight Board. In addition, Casey Family Programs, the nation’s largest operating foundation focused entirely on foster care and improving the child welfare system, has supported the reform effort from its inception providing financial resources, strategic consultation and technical assistance. Casey Family Programs has also connected DHS to other jurisdictions, facilitated transfer of learning and provided implementation support. The Foundation’s executive vice president, David Sanders, has also been a long-time member of the Community Oversight Board and currently chairs the committee.

Several other foundations have supported DHS’ initiative to overhaul its service delivery model, Improving Outcomes for Children (IOC). The Annie E. Casey Foundation has provided considerable resources and technical assistance to support various aspects of IOC including efforts to reduce the number of youth placed in congregate care, efforts to involve families and a wide range of professionals in case decision making (known as teaming) and efforts to assess the implementation of IOC. The Department also received a development grant for community engagement from the William Penn Foundation.

The city was also able to launch two new initiatives aimed at improving the educational outcomes of vulnerable children with generous support from both the Stoneleigh Foundation and the William Penn Foundation. These include a city-wide truancy reduction plan developed through a rigorous process of cross-system planning and collaboration as well as an Education Support Center to address the underlying issues that result in poor educational outcomes for children in care.

Finally, Philadelphia’s child welfare reform effort has benefited tremendously from the experience and best practices of child welfare agencies in other jurisdictions, particularly those who have implemented a community partnership approach to service delivery such as the State of Florida and New York City.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
The redesign of Philadelphia’s child welfare system represents a major philosophical shift in the way services are delivered to vulnerable children at risk of abuse and neglect. DHS has made a considerable effort to ensure the sustainability of the changes made.

To ensure financial sustainability, the agency took the lead in working with the Commonwealth to obtain a block grant from the federal government for placement costs. As a result of its efforts, Pennsylvania was one of only 9 states awarded this grant. This new approach to funding provides the flexibility for DHS to reinvest cost savings realized from its success in decreasing the number of children in placement into more innovative approaches to child safety. Thus the agency has been able to invest in services designed to prevent involvement with the child welfare system and to create a safety net at the neighborhood level.

The agency has also worked hard to transfer learning throughout the system so the knowledge and expertise provided by consultants is internalized by both agency and provider staff. It has also created a culture of quality improvement that is data-driven and encourages the system to learn from its mistakes. For example the agency regularly assembles professionals from a range of disciplines to discuss outcomes data and performance measures.

Community and family engagement and support also serve to help to ensure sustainability of the new service delivery model. A key component of the system redesign was building strength at the neighborhood level. To achieve this goal, DHS petitioned the Commonwealth for a regulatory waiver that allows the agency to delegate service delivery to trusted, culturally competent providers. The Department is enhancing the capacity of these providers through comprehensive training and technical assistance. The new model is also predicated on valuing families. Grounded in the recognition that family input is necessary to ensuring the best outcomes for children, the system relies heavily on teamings that draw upon family expertise to solve problems.

Staff buy-in has also been critical to sustainability of the redesign and DHS leadership continuously strives to instill a sense of pride and accountability at every level of the organization. Communication with staff is a top priority and the Department has established several forums through which it updates workers on initiatives and accomplishments including a new Website, two monthly newsletters, and the use of social media. It also offers mechanisms for staff to provide input on the reform efforts and regularly recognizes staff members for their achievements.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
In six years, Philadelphia’s child welfare system has transformed from a national disgrace to a national model. Today, DHS is accountable, proactive and keenly focused on its mission of child safety. As a result:

• Children are safer.
• Fewer children are in placement and at-risk families receive effective supports that enable them to remain intact.
• Of children who are in placement, fewer are in congregate care and fewer still are placed out-of-state.
• Children in care achieve permanency in greater numbers and spend less time in placement.

Many lessons were learned on the road to achieving these goals. Among the most important:

• Mission is the guiding force. DHS is charged with protecting Philadelphia’s most vulnerable children. But over time, bureaucratic tasks and paperwork took precedence over this urgent responsibility. The transformation of Philadelphia’s child welfare system required an unwavering recommitment to the mission of child safety at all levels. Today children are safer because every policy, practice and program upholds and reinforces this mission.

• The importance of partnership and inclusion. Child welfare is a community responsibility and DHS alone cannot solve the problems of abuse and neglect. During the past six years, the agency worked hard to build robust partnerships with a wide range of stakeholders including the courts, the police, the District Attorney’s Office, the School District, providers, advocates and the Commonwealth.

• The engagement of community members and constituents is critical to effective service delivery. With the development of IOC, the agency is working hand in hand with the communities where the children and families served live to create a service system that is informed by and speaks to the needs of those specific communities.

• Transparency enhances credibility. For years DHS was shrouded in secrecy, but the reform effort ushered in an era of transparency. By regularly and proactively sharing information with staff, providers, media, the public, policy makers, child advocates and other stakeholders, the agency has turned long time skeptics into supporters.

• Evidence-based practices result in better outcomes. With the support of Casey Family Programs DHS learned from the experience of other child welfare agencies and adopted the best practices in the industry. The foundation facilitated site visits that provided DHS staff the opportunity to view successful programs first hand. These trips informed many new DHS initiatives such as Parent Cafes, which are designed to strengthen the protective capacities of families by providing a forum for parents to gather and ask questions, and share information and resources.

• Measure outcomes. Learn from your mistakes. The establishment of the Division of Performance Management and Accountability was an essential component of the reform effort. By collecting and analyzing quality data, DHS can measure outcomes, identify concerns, target efforts, learn from its mistakes and improve its performance. In this way, the agency has nurtured a culture with the goal of continuous quality improvement. And while there is still a way to go, today at DHS there is a shared vision and a relentless urgency to become the best child welfare agency in the country.

Contact Information

Institution Name:   Philadelphia Department of Human Services
Institution Type:   Government Agency  
Contact Person:   Anne Marie Ambrose
Title:   Commissioner  
Telephone/ Fax:   215-683-6001
Institution's / Project's Website:
Address:   1515 Arch Street
Postal Code:   19102
City:   Philadelphia
State/Province:   Pennsylvania
Country:   United States

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