Changes ahead for DFCS

Moderated by Tom Sabulis

Bobby Cagle, Georgia’s new director of the Division of Family and Children Services, seems well-suited to the job. As a child of 10 months, he was adopted from the welfare system of North Carolina by “a loving family.” Today, Cagle outlines the changes he hopes will turn around the beleaguered DFCS. In our second column, also on the topic of children’s welfare, the commissioner of the state Department of Public Health writes about the importance of getting vaccinated for measles.

A blueprint for DFCS change

By Bobby Cagle

I believe in striving for excellence and setting the bar high, particularly when the stakes are high. When charged with protecting the safety and welfare of children, the stakes couldn’t be higher. That is why employees of the Division of Family and Children Services often hear me say our goal is to provide the best child welfare and family independence services in the world.

Ambitious? Certainly. But I clearly see how we can get there.

DFCS’s “Blueprint for Change” outlines high-level, interdependent changes that will put us on the path toward achieving our goal. As we develop specific actions, I believe conventional wisdom will shift toward one of great confidence in our ability to accomplish real change and to achieve measurable outcomes to the benefit of Georgia’s children and families.

The plan incorporates recommendations of the Child Welfare Reform Council created by Gov. Nathan Deal to address challenges facing the child-welfare system in the categories of safety, permanency and well-being.

The most important aspect is to develop a robust workforce supported by best practices for caseloads, with resources to help people do their jobs effectively and safely.

We are working toward a child welfare caseload ratio of 1:15, consistent with the Reform Council’s recommendation. This will bolster our ability to assess the safety of children who come to our attention. We are already making progress reducing caseloads and the number of pending investigations even with unprecedented increases in the number of Child Protective Services reports.

We have added nearly 275 new staff in the past year and continue to hire. Adequate staffing gives us the capacity to effectively serve the one in five Georgians who count on our assistance to care for their families.

With Georgia Tech, we are developing a high technology “panic button” to help keep staff members safe as they visit families in their homes, many times at night and alone. We are also enhancing systems we use to track and monitor cases.

Additionally, we will improve supervisory practices to ensure we are mentoring those who may not have adequate experience in the field. Classroom training alone doesn’t suffice. As a former caseworker, I can attest to the importance of a good mentor to impart wisdom when dealing with the pressures and unpredictable situations DFCS investigators face.

We acknowledge not all of our tasks can be undertaken in a purely prescriptive manner, and that much of our success depends on the professional judgment of our caseworkers and their supervisors. To improve outcomes, supervisors should help caseworkers develop judgment skills to supplement their training on policies and procedures.

It is vital that we identify, adopt and adhere to a proven-practice model that recognizes the connectedness and interdependence of all our functions, how we perform them, and the family dynamics of those we serve. We must decide on — and be clear about — our key values and guiding principles, which we are now defining. This will determine how we assess child safety and family strengths and deficiencies going forward and guide our case planning.

At the same time, we plan to strengthen local office resources to allow families to apply and renew their benefits with a local case manager. We will continue to offer services through our call center as well.

Constituent engagement is the third component of our blueprint. Too often, agencies roll out changes without first having conversations with key stakeholders, internal and external. That is a mistake. Participatory planning helps develop workable and sustainable solutions, and it leads to buy-in, which increases commitment to successful implementation.

We want to better engage those connected to the recipients of our services — law enforcement and emergency responders, pediatricians, school counselors and teachers, members of the judiciary, legislators, business and religious leaders, members of the media, and more — as well as the recipients themselves, including former foster children.

Pursuant to Reform Council recommendations, we also will be communicating with Department of Family and Children Services boards at the county level and plan to create district-level DFCS advisory boards to improve service delivery and policy implementation in each district.

Clearly, there is much work to be done. This high-level plan sets direction and establishes guidelines, but will require an intense strategic process to put into practice. We have massive challenges ahead, but I am confident in our ability to meet them and excel on behalf of Georgia’s children and families

Bobby Cagle is director of Georgia’s Division of Family and Children Services.

Stop measles in its track

By Brenda Fitzgerald

There is an infant in Georgia who may one day learn what a stir he created with his arrival in Atlanta from Kyrgyzstan a little more than a week ago. That little one brought with him the state’s first reported case of measles in three years.

He couldn’t have known how contagious measles is. Just as he unintentionally contracted it from an infected person in Kyrgyzstan, he unwittingly exposed at least 230 others to measles while traveling to Atlanta and after he arrived.

Measles spreads when an infected person coughs or sneezes. Droplets from the nose or mouth become airborne or land on surfaces where they can live for two to three hours. A person with measles doesn’t even have to be present for someone else to be infected. Anyone can get measles if they are not vaccinated or don’t have measles immunity.

This is a serious disease that can lead to dangerous complications such as pneumonia, encephalitis (swelling of the brain), even death. The Centers for Disease Control and Prevention tells us that for every 1,000 measles cases reported in the United States, two to three deaths will occur.

That sounds dire – and make no mistake, as a doctor I know the many devastating consequences of measles – but the disease can be prevented with the MMR (measles, mumps, rubella) vaccination. MMR is 97 to 98 percent effective, making it one of our best vaccines.

The CDC recommends children receive their first dose of MMR vaccine between 12 and 15 months of age, and a second dose between 4 and 6 years old. In Georgia, it’s more than a recommendation, it’s the law. Children must have two doses of MMR vaccine before they can enroll in day care or kindergarten.

In fact, 98.3 percent of Georgia’s children enrolling in kindergarten have received all required vaccinations, including MMR. The state allows only two exemptions: a medical exemption for those with compromised immune systems who cannot safely be vaccinated, and a religious exemption for those who provide a sworn statement indicating their religion forbids vaccination.

Most people born before 1957 have already suffered through measles. The good news for them is that once you’ve had measles, you have lifetime immunity. But between 1963 and 1967, many people received a vaccine with inactive or killed virus that was not as effective as we had hoped. It is very important for adults in their 50s to be checked for measles immunity. A simple blood test is all it takes.

Today, the MMR vaccine contains a live, but weakened, form of measles virus. When a person is vaccinated, that virus triggers a response similar to actually having measles, which then provides immunity.

I have heard all of the arguments against vaccination from those who believe it can cause health problems, such as autism. In my 30 years in medicine, there has never been any scientific evidence or firsthand anecdotal evidence that MMR or other vaccines cause autism.

The question about a possible link between MMR vaccine and autism has been extensively reviewed by multiple independent groups of experts in the U.S., including the National Academy of Sciences’ Institute of Medicine. These studies and reviews have all concluded there is no association between MMR vaccine and autism.

As public health officials, we can take great pride that measles was declared eliminated in the United States in 2000. But we also know that in this global community of constant travel, new cases can become outbreaks in a matter of hours. Parents and physicians need to be alert and pro-active. Vaccination is our best protection against measles and a host of other infectious diseases.

My hope is that little one from Kyrgyzstan who is now recovering from measles will grow up to learn he made quite an impact on our state – reminding Georgians of the pressing need to be vaccinated so we can stop this preventable disease in its tracks.

Dr. Brenda Fitzgerald is commissioner of the Georgia Department of Public Health.

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