state case studies

The core team was convened and staffed on a day-to-day basis by personnel at the Kentucky DCBS. The core team met on an approximately monthly basis to discuss project updates and ensure that the project stayed on schedule. The team included the state senator who chaired the Kentucky Senate Committee on Health & Welfare, the commissioner of the Kentucky DCBS, the state’s child welfare agency and the AOC.

The implementation team, which included representatives from multiple public and private agencies, met once as a large group, with ongoing contact through small-group meetings and by email. Members of the core and implementation teams struggled with constraints on time and their ability to carry out their ambitious agenda, but the meetings they held were worthwhile to the key state partners who attended them in terms of building support, planning and disseminating best practices across the state.

Kentucky’s three-branch approach created a lasting culture of collaboration and engagement among the three branches. The greatest success that the team lead identified was the positive momentum, commitment and strong partnerships forged among public partners of all branches of government and private partners. The strong partnership between the core team and the implementation team helped increase the capacity of the three-branch approach team in carrying out its overall vision. The initiative created peer learning opportunities where attendees heard about innovative approaches and best practices. The key advocates, program administrators and political leaders who participated committed to maximizing their resources to effect positive change for Kentucky’s families and children.

The three-branch approach affected policy and practice in each branch of state government. Judges can access training on parental substance abuse and substance-exposed newborns at a variety of judicial conferences to ensure that they are fully prepared to work with families dealing with SUD that appear before them in court. The AOC and DCBS worked with Jefferson County to establish a family drug court with the help of a private philanthropic group. The Legislature used its new knowledge of kinship care to pass legislation that would recognize fictive kin as a placement for a child and maintain current Kentucky practices in compliance with the Child Abuse Prevention and Treatment Act. The initiative informed the state child welfare agency’s legislative proposal and budget request for the 2018 session, including House Bill 1, an omnibus child welfare bill that was a priority of the 2018 Kentucky General Assembly. Finally, agency leadership amended administrative regulations governing child protective services initiation time frames, which were also subject to legislative oversight. The time frame change adopted in December 2017 was informed and supported through technical assistance received through the three-branch project.

The core team met weekly to discuss project updates and troubleshoot challenges to implementing the strategic plan. The larger implementation team met monthly and included:

• Representatives from Maryland Department of Health.
• Additional legislators from the Maryland House of Delegates and Senate.
• A representative of county government. A representative from the Maryland Chapter, American Academy of Pediatrics (MDAAP).
• A data analyst from the university system.
• A representative from the home visiting program.
• A representative from the law school legal clinic.
• A representative from a major nonprofit child welfare provider.

Maryland often invited outside experts to present at core and implementation team meetings on issues relevant to their teams’ goals. In this way, core and implementation team members had the opportunity to learn together, building a shared sense of both the issue and the best strategies for moving forward. Team leads noted that legislators and judges remained involved in the core team but frequently attended and actively participated in implementation team meetings.

In developing its strategic plan, the teams identified several activities designed to improve early identification of high-risk populations and provide appropriate services to decrease the impact of substance exposure on newborns.

Maryland’s three-branch initiative created a lasting culture of collaboration and engagement among the three branches. In addition, the peer learning opportunities provided at the core and implementation team meetings helped members of each branch develop a more comprehensive understanding of best practices for serving substanceexposed newborns and their families. Representatives of each branch worked to advance and implement policy and practice changes to create better outcomes for children and families in the state of Maryland.

Executive branch outcomes included the following:

• Expanded the service array of evidence-based practices to help children and parents when substance misuse was detected
•  Launched a training program to help child welfare workers better understand SUD and how it intersects with child welfare while also implementing evidence-based practices to serve parents with SUD.
• Agency-wide changes provided training for child welfare, home visiting, and infant and toddler program frontline staff to better serve substance-exposed newborns and families affected by SUD in an interdisciplinary way

Legislative branch outcomes included the following:

• Enacted 2018 House Bill 1744, Chapter 410, to bring the state into compliance with the CARA requirements for child welfare notification of a substance-exposed newborn.

Judicial branch outcomes included the following:

• Creation of judicial training opportunities for judges on parental substance abuse and substance-exposed newborns at annual conference and at other educational convenings.
• Developed a plan for consistently applying CARA requirements to the creation and monitoring of plans of safe care throughout the state.

Virginia DSS created a project manager position to staff its initiative by reassigning duties from an existing position within Virginia DSS. This project manager was responsible for managing day-to-day operations of the three-branch initiative, including developing meeting agendas, managing communications between branches and following through on action items.

The state formed work groups based on the four strategic goals:

• Increase understanding of risk and protective factors that are predictive of or associated with child maltreatment and child fatalities
• Assess the effectiveness of existing screening, safety and risk tools, and explore the development of new or expanded policies, practices and protocols
• Strengthen existing efforts to enhance child safety through primary prevention and family engagement strategies across systems.
• Enhance child welfare recruitment and retention efforts to create and sustain a culture of safety in the workforce.

Those work groups included members of the core and implementation teams, who met frequently to discuss project updates related to their individual work group goal. At core and implementation team meetings, representatives from the different work groups would provide status updates from their work groups to the larger team. The team would use these meetings to share lessons learned from work groups and to address challenges to accomplishing their goals.