{"Multiple_Choice__291":"Kristine Frick","Short_Answer__292":"Kari Rude","Date__293":"12\/13\/2018","Multiple_Choice__294":"Near Fatality","Yes_or_No__295":"No","Multiple_Choice__300":"3","Multiple_Choice__301":"Stevens","Short_Answer__303":"Rafael","Short_Answer__304":"Crayton","Date__305":"01\/24\/2018","Date__307":"08\/10\/2018","Multiple_Choice__308":"7 Months","Multiple_Choice__309":"2","Short_Answer__310":"Mother","Short_Answer__311":"Mother's boyfriend","Multiple_Choice__316":"2","Short_Answer__317":"A requested TPR was not filed by the County Attorney for an alleged father who was a registered predatory offender and a mother with an egregious harm maltreatment determination.","Free_Text__318":"Consults between CP and CA occurred (multiple)\r\n\u00e2\u20ac\u00a2\tPetition written and provided to the CA\r\n\u00e2\u20ac\u00a2\tFiling TPR was declined \r\n\u00e2\u20ac\u00a2\tCA unsure if met TPR criteria\r\n\u00e2\u20ac\u00a2\tInexperience in both work areas; Social Services Staff and CA's office\r\n\u00e2\u20ac\u00a2\tCA no mentor assisting; Not using green book\r\n\u00e2\u20ac\u00a2\tCA want criminal case to go first before filing TPR","Free_Text__319":"A Termination of Parental Rights (TPR) was not filed by county attorney (CA) under the predatory offender statute or maltreatment determined egregious harm statute although child protection (CP) staff had multiple consults with the CA throughout the life of the case regarding child safety and best interest factors.  CP Staff drafted a petition and provided it to the CA, describing the circumstances which CP perceived to meet the TPR criteria, as CP perceived they were implementing and completing the required tasks based on their interpretation of the predatory offender and egregious harm guidance, stemming from MN laws. \r\nBest practices prescribed for these types of cases and actual support received by CP from the CA was not congruent across the systems when CP petitioned for TPR, as the CA was not certain that criteria for TPR was met, and made the decision to not file for TPR. Both the CA and CP staff had little longevity with staff experience, and a knowledge gap presented difficulties integrating knowledge into practice, influencing the trajectory of case practice. There is a lot of information to take in when learning new roles in both professions, where professionals experience a window of time called a learning curve. \r\nIn regard to the CA working a new role, there is little assistance from other attorney's to mentor each other, and their workload influences the amount of time available for learning and interpreting laws, as in the predatory offender and egregious harm statues involved in this case.  CP's mental model was that the new CA was not using the green book to guide decisions either and staff perceived the absence of requisite knowledge contributed to the CA not filing for TPR in accordance with statutes.  \r\nThere was no legal basis under compelling reasons as the crime and egregious harm occurred in the past, and the child was presumed safe in real time. There was no present imminent harm or imminent danger to the child, therefore the CA did not prioritize filing for TPR. There was also a perception that the public places higher preference on criminal case outcomes over TPR cases, and the criminal proceedings had not been completed at the time CP drafted a petition for TPR. The CA also prioritized the criminal case proceedings over filing for TPR, as using the result of the criminal case to support meeting criteria for TPR is common practice for county attorneys.","Short_Answer__320":"CP Intake was not screened within the 24 hour required timeframe","Free_Text__321":"\u00e2\u20ac\u00a2\tWait for conformed test results\r\n\u00e2\u20ac\u00a2\tMother move around, jurisdiction concerns, mother was hard to reach\/ difficulty engaging to conform where reside and find the family's location\r\n\u00e2\u20ac\u00a2\tPositive for THC only = not as severe as meth, etc. \u00e2\u20ac\u0153it's just THC\u00e2\u20ac\u009d, mental model for agency's about what this means\r\n\u00e2\u20ac\u00a2\tPrevious PSOP  and CD assessment\r\n         -Mother declined services & no recommendations came out of the CD assessment\r\n\u00e2\u20ac\u00a2\tOne Primary intake worker\r\n         - Back up took intake info may not be as familiar \tw\/internal processes for intakes since it's not their primary role the staff commonly \tworks every day.  \r\note: presumptive  Vs Confirmed results","Free_Text__322":"Learning Point: A CP intake was not screened within 24 hours. \r\nContributing to the CP intake not being screened within 24 hours was the type of allegation that was reported, neglect - prenatal exposure to controlled substance. The agency made a decision to hold off on screening the maltreatment report that was entered into SSIS by a backup staff. The back-up intake worker was balancing intake responsibilities with responsibilities of their primary workload, which resulted in tradeoffs. Additionally, the backup staff was not as familiar with intake procedures, as local agency practices for prenatal exposure reports had recently changed, which occurred following changes to DHS's maltreatment, screening, and response path guidelines. The changes to the guidance stemmed from DHS's interpretation of legislative changes around prenatal exposure and best practices were also defined by the state from Legislative statutes. Also influencing was a local agency workgroup, where their input and feedback on practical implementation strategies in response to prenatal exposure allegations was incorporated into the changes to guidance. The changes in guidance can conflict with the mandate to screen reports within 24 hours, as obtaining comprehensive information at the time of the report can take longer than 24 hours to receive.  \r\nThe agency interpretation of guidance influenced an internal practice change, where the agency held intakes open for prenatal exposure until they received more comprehensive collateral information from the medical provider. The agency's new practice prioritized making screening decisions based on lab verified toxicology results versus a positive result on an initial screening. Hospitals have policies and practices that vary in regard to testing for prenatal exposure and also for when they make a report for prenatal exposure allegations to child protection. The variability suggests some hospitals test all children, where others only test when certain criteria\/risks exist when the child is born. It is collectively known that some providers may test more mothers of marginalized groups using their mental models rooted from past experiences, creating an implicit bias. This bias subjects children of marginalized groups, and their mothers to increased toxicology testing, and potentially increases the number of reports made to child protection system when results are positive. It is also collectively known that other providers perceive there being a need to preserve the patient\/doctor relationship which also influences a confirmed positive toxicology report being made or not. This information on testing and reporting variability across hospitals influenced the agency's decision to wait for lab confirmed toxicology results before screening the report.  \r\nThis practice change was an adaptation from how the agency previously screened out prenatal exposure reports (prior to receipt of confirmed toxicology results) in order to meet the 24 hour timeline. Further Influencing the decision to not screen within 24 hours and wait for a confirmed toxicology result, was the agency's past experience of getting involved and working with families based on a positive initial screen, and later receiving information that the initial screen proved to be inaccurate and was a false positive. The agency worked to find balance between two priorities, the agency's role to protect children from harm and keep them safe, and the agency's duty to protect the privacy of children and families by not getting involved unjustly when credible evidence does not suggest alleged maltreatment. This goal conflict influenced the agency's decision to hold off on making a screening decision. \r\nThe local agency's interpretation of all the guidance changes supported their decision to seek collateral comprehensive information, which is suggested as best practice. Understanding it takes time, and the amount of time it takes to receive confirmed toxicology results from the lab is also dependent on, which type of toxicology test the medical provider chooses to order (urine sample, meconium, or blood cord tissue). For this case, a blood cord tissue sample was chosen, which provides most accurate results of toxicology, however, takes the most time for the lab to provide a report on the confirmed toxicology results. The time needed for child protection to wait for confirmed toxicology results contributed to the delay in screening. \r\nThe maltreatment, intake, screening, and response path guidance also require that agencies focus on vulnerability and risk of harm by assessing the impact chemical use or misuse has on child safety and use this as the primary consideration when screening. Understanding the mother's use alone did not constitute an unsafe child, the agency resolved the goal conflict by prioritizing the clause about \u00e2\u20ac\u02dcimpact of use or misuse on child safety', as the guidance suggests this be the primary consideration when screening. Furthermore, the agency considered risk associated with type of drug in which results are positive, for example, response to an allegation involving THC can be different than a response to an allegation involving methamphetamine. Since the child was presumed safe, consideration was given to the best interest of the child, and the agency sought to use a trauma informed approach that honored the newborn's innate biological needs for physical touch, bond, and attachment with the mother, prioritizing the presumption of safety over meeting the 24 hour screening compliance metric.","Multiple_Choice__346":"3","Free_Text__347":"LP1:  CP's mental model was that the new CA was not using \"the green book\" to guide their decisions, and staff perceived the absence of requisite knowledge contributed to the CA not filing for TPR in accordance with statutes. \r\nCP also developed a mental model regarding not receiving support from their CA due to a history of denial to file for TPR.","Multiple_Choice__348":"3","Free_Text__349":"LP1: Stevens County has limited staff employed, leaving little time for staff to mentor the CA, as priority is given to working CP cases coming into the system. When cases are exceptionally complex, staff do not sleep or sleep at the office to complete work tasks for complex cases.","Multiple_Choice__350":"0","Multiple_Choice__352":"0","Multiple_Choice__354":"3","Free_Text__355":"LP1: A Termination of Parental Rights (TPR) was not filed by county attorney (CA) under the predatory offender statute or maltreatment determined egregious harm statute although child protection (CP) staff had multiple consults with the CA throughout the life of the case regarding child safety and best interest factors.  CP Staff drafted a petition and provided it to the CA, describing the circumstances which CP perceived to meet the TPR criteria, as CP perceived they were implementing and completing the required tasks based on their interpretation of the predatory offender and egregious harm guidance, stemming from MN laws. \r\n \r\nThere was no legal basis under compelling reasons as the crime and egregious harm occurred in the past, and the child was presumed safe in real time. There was no present imminent harm or imminent danger to the child, therefore the CA did not prioritize filing for TPR. There was also a perception that the public places higher preference on criminal case outcomes over TPR cases, and the criminal proceedings had not been completed at the time CP drafted a petition for TPR. The CA also prioritized the criminal case proceedings over filing for TPR, as using the result of the criminal case to support meeting criteria for TPR is common practice for county attorneys.","Multiple_Choice__356":"3","Free_Text__357":"LP1: Best practices prescribed for these types of cases and actual support received by CP from the CA was not congruent across the systems when CP petitioned for TPR, as the CA was not certain that criteria for TPR was met, and made the decision to not file for TPR. Both the CA and CP staff had little longevity with staff experience, and a knowledge gap presented difficulties integrating knowledge into practice, influencing the trajectory of case practice. There is a lot of information to take in when learning new roles in both professions, where professionals experience a window of time called a learning curve. \r\nIn regard to the CA working a new role, there is little assistance from other attorney's to mentor each other, and their workload influences the amount of time available for learning and interpreting laws, as in the predatory offender and egregious harm statues involved in this case.  CP's mental model was that the new CA was not using the green book to guide decisions either and staff perceived the absence of requisite knowledge contributed to the CA not filing for TPR in accordance with statutes.","Multiple_Choice__368":"0","Multiple_Choice__358":"3","Free_Text__359":"LP1: A Termination of Parental Rights (TPR) was not filed by county attorney (CA) under the predatory offender statute or maltreatment determined egregious harm statute although child protection (CP) staff had multiple consults with the CA throughout the life of the case regarding child safety and best interest factors.  CP Staff drafted a petition and provided it to the CA, describing the circumstances which CP perceived to meet the TPR criteria, as CP perceived they were implementing and completing the required tasks based on their interpretation of the predatory offender and egregious harm guidance, stemming from MN laws. \r\nBest practices prescribed for these types of cases and actual support received by CP from the CA was not congruent across the systems when CP petitioned for TPR, as the CA was not certain that criteria for TPR was met, and made the decision to not file for TPR. Both the CA and CP staff had little longevity with staff experience, and a knowledge gap presented difficulties integrating knowledge into practice, influencing the trajectory of case practice. There is a lot of information to take in when learning new roles in both professions, where professionals experience a window of time called a learning curve. \r\nIn regard to the CA working a new role, there is little assistance from other attorney's to mentor each other, and their workload influences the amount of time available for learning and interpreting laws, as in the predatory offender and egregious harm statues involved in this case.  CP's mental model was that the new CA was not using the green book to guide decisions either and staff perceived the absence of requisite knowledge contributed to the CA not filing for TPR in accordance with statutes.  \r\nThere was no legal basis under compelling reasons as the crime and egregious harm occurred in the past, and the child was presumed safe in real time. There was no present imminent harm or imminent danger to the child, therefore the CA did not prioritize filing for TPR. There was also a perception that the public places higher preference on criminal case outcomes over TPR cases, and the criminal proceedings had not been completed at the time CP drafted a petition for TPR. The CA also prioritized the criminal case proceedings over filing for TPR, as using the result of the criminal case to support meeting criteria for TPR is common practice for county attorneys.","Multiple_Choice__360":"1","Multiple_Choice__362":"3","Free_Text__363":"LP1: A Termination of Parental Rights (TPR) was not filed by county attorney (CA) under the predatory offender statute or maltreatment determined egregious harm statute although child protection (CP) staff had multiple consults with the CA throughout the life of the case regarding child safety and best interest factors.  CP Staff drafted a petition and provided it to the CA, describing the circumstances which CP perceived to meet the TPR criteria, as CP perceived they were implementing and completing the required tasks based on their interpretation of the predatory offender and egregious harm guidance, stemming from MN laws. \r\nBest practices prescribed for these types of cases and actual support received by CP from the CA was not congruent across the systems when CP petitioned for TPR, as the CA was not certain that criteria for TPR was met, and made the decision to not file for TPR. Both the CA and CP staff had little longevity with staff experience, and a knowledge gap presented difficulties integrating knowledge into practice, influencing the trajectory of case practice. There is a lot of information to take in when learning new roles in both professions, where professionals experience a window of time called a learning curve. \r\nIn regard to the CA working a new role, there is little assistance from other attorney's to mentor each other, and their workload influences the amount of time available for learning and interpreting laws, as in the predatory offender and egregious harm statues involved in this case.  CP's mental model was that the new CA was not using the green book to guide decisions either and staff perceived the absence of requisite knowledge contributed to the CA not filing for TPR in accordance with statutes.  \r\nThere was no legal basis under compelling reasons as the crime and egregious harm occurred in the past, and the child was presumed safe in real time. There was no present imminent harm or imminent danger to the child, therefore the CA did not prioritize filing for TPR. There was also a perception that the public places higher preference on criminal case outcomes over TPR cases, and the criminal proceedings had not been completed at the time CP drafted a petition for TPR. The CA also prioritized the criminal case proceedings over filing for TPR, as using the result of the criminal case to support meeting criteria for TPR is common practice for county attorneys.","Multiple_Choice__364":"1","Multiple_Choice__366":"0","Yes_or_No__370":"Yes"}