Now entering its fifth year, the Georgia Cold Case Project is designed to change outcomes for children who have been in care for years and are likely to age out of care without achieving permanency. The project is a joint effort of the Georgia Division of Family and Children Services (DFCS) and the Supreme Court of Georgia Committee on Justice for Children (J4C), supported with funding and expertise from Casey Family Programs and other private funders.
Like the police teams after which the project is named, the goal is to bring fresh eyes and attention to individual cases that may not have progressed. In addition to seeking permanent families for the children deemed likely to age out, the project makes concerted efforts to learn from the children’s cases in order to make broader systemic improvements.
Implementing Quality Assurance
When a committed group of people in Georgia’s child welfare system decided to start the Cold Case Project, we looked to hospitals’ quality assurance (QA) teams as a model. QA teams constantly survey and monitor hospital infection rates, mistakes, and general functioning of the health system. When they find mistakes, a team reviews what happened and either corrects the mistake or works to put processes in place to prevent the problem in the future. Hospitals have labeled certain mistakes as “never events”—errors that should never happen. While never events still occur, constant QA monitoring efforts are the best hope of preventing and reducing the frequency of these events.
Child welfare systems do not have this level of rigor and discipline in checking, double checking, and triple checking their work. Professor Eileen Munro, who has a background in economics, has written extensively about the need for QA in the child welfare system (including a book titled Effective Child Protection). In a New York Times article* and the book Reforming Child Welfare, former Washington, D.C. Child Welfare Director Olivia Golden urges child welfare systems to create a culture where reporting mistakes is encouraged and rewarded, not punished. The federal government is urging states to adopt continuous quality improvement (CQI) efforts in all strategic and funding plans. But rigorous CQI work has been slow to take hold.
This slowness may be due to the lack of leadership stability in most child welfare systems (the average tenure of a child welfare director is 18 months) or systems’ orientation toward crisis work (although hospitals are certainly built to handle crisis as well), but most likely the reason is the newness of the concept of scientific monitoring in child welfare systems. The very first Child and Family Services Review for states’ children welfare systems began in 2001 while hospitals’ QA leader and accrediting body—The Joint Commission—has been in place and had the force of law since 1965.
Georgia’s Cold Case Project was set up to monitor one part of the child welfare system—and to improve permanency and well-being outcomes for children who are languishing in care.
Operating the Cold Case Project
The process begins by using statistical analysis to identify which of the 7,000 children in Georgia’s foster care system appear to be at greatest risk of aging out without permanency. A computer model assesses the factors most likely to indicate a child will leave care without a family, which are currently:
- length of time in care
- placement type — The more institutional a child’s placement is, the more likely a child is to age out.
- per diem rate — A high per diem increases a child’s risk of aging out. When a child’s per diem is high it means medical staff or shift workers are caring for the child as their profession. In a family or small group home, a child is more likely to be cared for by people with whom they can build ongoing relationships.
Each factor alone does not predict how cold a case is; it is the combination of these three factors together that are highly predictive of a child’s risk of aging out of care.
When the project started in 2009, the coldest cases were those of children who had been bouncing around in care for more than eight years. Now the coldest cases are closer to three to five years old. In 2012, the children served by the Cold Case Project had a median age of 11.6, with one-quarter younger than 7. The children and youth were ethnically diverse and came from all around the state. Half of the children had been in state custody for at least 36 months, and 73 percent had an identified disability.
Once cold cases are identified, a team of lawyers takes over. These Supreme Court fellows first receive about 30 hours of training on funding streams, child welfare legislative history, complex trauma, and the education and health rights of foster youth. Then they take a test to ensure they are knowledgeable about child welfare.
While changing a possible bad outcome for a child can be exciting, the day-to-day work of the project is not always riveting. Cold Case teams spend hours and hours carefully reading case files, recording information and discrepancies they find, writing up reports, updating spreadsheets, tracking tasks, and periodically discussing cases with one another. This work, while sometimes tedious, is necessary to change and improve systems that, in turn, can improve children’s lives.
As part of the review, the fellows use a pre-designed instrument to identify legal barriers to permanency. In addition to summarizing the child’s reason for being in care and changes in placements and case plans, the instrument tracks if scheduled hearings took place, whether reasonable efforts were made, if the child or birth parents have attorneys or advocates, and what efforts were made to achieve permanency. It also lists all family members found during any diligent searches. The reviewers then write a narrative of the case and discuss it with the child’s workers and others involved. Often, they host a permanency roundtable where all involved parties discuss a child’s case, brainstorm ideas for permanency resources, and develop recommendations to improve the likelihood of permanency for the child. Whenever possible, the youth attends the roundtable too.
The project’s lawyers can also turn to other team members for help. A retired Atlanta police officer and current private investigator can identify children’s family connections and track down important people in a child’s life. A psychiatrist, a public defender (for children who have been arrested), social workers, an adoption recruiter, a mediator, and a public relations expert are also available when their help is needed.
Beyond digging into files, the Cold Case Project undertakes a number of other activities to help children achieve permanency, including arranging counseling to help children consider adoption or guardianship, and continuing to monitor the case over time. The project has hosted adoption parties to recruit families for children, offered children tutoring, supported visits with prospective families, hosted trainings on trauma-informed care, and paid for transportation to visits with relatives.
B’s case illustrates the process of the Cold Case Project. B’s records appeared on the Georgia Cold Case list in 2010 when he was 16. He had been adopted in another state, but his adoptive parents abandoned him and he had spent many years in a group home at a fairly high per diem with no adult connections outside of child welfare system employees. After the Cold Case team reviewed, summarized, and discussed B’s large case file, they reached consensus that B’s original adoptive file should be opened to see what had happened to his biological family. The effort to open the file took more than seven months, with the team responding to legal hurdles and often-unnecessary objections. From the original file, the team identified some family members, and a private investigator was able to locate them. Once B’s biological parents were found (along with a big network of extended family), B’s mother immediately got in touch with B, and they began building a solid relationship. B’s case manager said B is doing better just by knowing his mother, his family, and his human connections, stating recently, “I can see now that B really needed to belong to somebody in order to feel better.”
Another case highlighted the different resources the Cold Case Project can bring to bear. Seventeen-year-old Ian had been in care for more than four years. As part of the review, the case manager located Ian’s paternal grandparents in Massachusetts. The grandparents had lost touch with Ian and assumed he had been adopted already. Once they learned Ian was still in care, they wanted to see him right away. Using funds from a foundation grant, the Cold Case Project was able to cover the grandparents’ travel expenses to Georgia so they could visit Ian without delay. After the visits, the grandparents adopted Ian, and he moved to Massachusetts to live with them.
From the start, the Cold Case Project has helped children achieve permanency. Children served by the project in 2009 were more likely than a 2008 comparison group to exit to permanency and had shorter stays in care. Children served in 2011 were 25 percent more likely than a comparison group to exit care to a permanent family.
During their reviews, the fellows have identified a number of barriers to permanency, with problems caused by the child welfare system, the courts, and family members. For the child welfare system, the reviews found issues with:
- failing to diligently pursue relatives or other key individuals as placement resources
- lack of timely intervention with the child’s birth family
- failure to consider a broader range of placements (such as with an older sister or brother or returning to a birth parent after a number of years)
- case manager turnover
- overuse of psychotropic medication
- not enough attention paid to children’s legal rights
- lack of resources
Problems found in courts included delays, missing or inaccurate petitions and motions, lack of attorney action, and insufficient judicial oversight. Family problems primarily involved failure to follow case plans and inability to address children’s special needs.
As a result of its first year of reviews, the project made 15 recommendations for system-wide reforms, including:
- make timely and detailed diligent searches a priority
- limit the use of another planned permanent living arrangement as a permanency plan
- ensure children have connections to family or other important adults
- involve children in permanency planning
- improve judicial oversight of permanency issues
- provide services and supports to adoptive families to reduce adoption dissolution
- use adoption counselors and specially trained staff to reduce a child’s resistance to adoption
- expand the use of family dependency treatment courts to help birth parents address the circumstances that brought them in contact with child welfare
Simply identifying the cold cases and talking about the issue also returned gains. By virtue of announcing and describing the project, people changed their practices to mirror the message and values of the Cold Case and Permanency Roundtable projects. Once we developed a tangible list of children in state custody and promised that a review by the Supreme Court team was coming, some children on the list began to move toward permanency. By design, the project prioritized these children for increased attention and work effort—attention they needed and deserved.
During 2013, the Cold Case Project revived and reviewed 250 children’s cases from the cold case list. The work the team does isn’t difficult, although it can be time-consuming. By investing the team and effort, we have improved many children’s chances of achieving permanency and building long-term family connections. We have also learned lessons we can implement to improve the system for other children.
We have also learned that we need to catch cases earlier. In the future, the team will begin to review “cool” cases as well as cold ones. As Georgia continues to refine and expand its Cold Case Project, other states are creating their own programs—both West Virginia and Florida have recently begun similar efforts.
For those of us working in Cold Case Projects, the goal is that a case like B’s will become a “never event.” No child should wait seven years for the system to help him find permanent family connections. By investing time in quality assurance monitoring, attention to detail, reviewing and checking back again and again, we can ensure that children’s needs are much better served. We hope that we can institutionalize the efforts of the Cold Case Project, making these efforts part of the routine business of child welfare in Georgia—and nationwide.