Serious questions about DHS care

For decades, Philadelphia's Department of Human Services paid private contractors tens of millions of dollars to check on vulnerable children but did little to make sure those checks were actually happening.

An Inquirer review found an oversight system that amounts to little more than a paper shuffle, where auditors review forms yet seldom talk to the people they're supposed to help.

"It's clear to all of us that DHS got sloppy in its oversight; that is certainly an understatement," said Frank Cervone, a child-welfare advocate serving on a mayoral panel charged with cleaning up the department.

Typically, when DHS child-abuse workers see warning signs of abuse or neglect, they hire private contractors to help protect children at home and keep families together. The department relies on this program, known as Services to Children in Their Own Homes, or SCOH, because DHS workers don't routinely visit clients. They oversee 40 contractors who care for nearly 7,000 city children every year.

But an Inquirer review of hundreds of city performance evaluations and contracts, along with interviews with officials and private caseworkers, uncovered a system riddled with flaws. Among them:

Audits show that DHS cited some providers for the same failures year after year and then ignored its own recommendation that those contractors stop receiving cases. In 30 years, records show, DHS officials terminated just three of them.

Unlike some other cities, Philadelphia does not require private providers to bid competitively for work. Two years ago, when City Council pushed for bidding rules for those contracts, DHS officials succeeded in killing the proposal, saying it would decimate the relationship between providers and the families they serve.

As far back as 1988, auditors have urged DHS to strengthen its oversight of welfare workers. Again in 1997, auditors made similar findings. But DHS took little action.

Such lapses can have tragic consequences.

Last summer, Danieal Kelly, a 14-year-old with cerebral palsy, died of neglect while DHS and a private provider, MultiEthnic Behavioral Health, were supposed to be checking on her.

After revelations about her case, Mayor Street dismissed the top two officials in DHS and appointed the reform panel.

State and federal prosecutors have launched criminal investigations into MultiEthnic amid allegations that a company caseworker stopped showing up at the Kelly home. A lawyer for MultiEthnic said the firm bore no responsibility for Danieal's death and that its records showed 18 visits to the Kelly home in the two months before the girl was found dead.

City records show DHS gave "outstanding" marks to MultiEthnic, according to the most recent evaluations made available to The Inquirer. "Extremely energetic," the department raved, saying caseworkers worked nights and weekends to meet with families.

The panel on which Cervone serves is studying 52 cases of children who died in the last five years after they or their families came to the attention of DHS. The panel's findings, due out tomorrow, are expected to fault weak oversight of the contractors.

Acting DHS commissioner Arthur C. Evans Jr. said that since he took charge of the department after the Inquirer investigation in October, DHS had sought to completely change how it monitors contractors. Social workers have conducted safety checks - in person - of nearly 7,000 children who receive services at home.

Meanwhile, the department has stopped sending new clients to five providers and terminated its contract with two more, including MultiEthnic.

Evans said the department planned to hire five more staffer to oversee contracts and shift to a system that measures how well children are cared for and not just how well private providers complete reports. He said DHS workers now ask clients whether providers are showing up and will soon start monthly spot checks. But Evans cautioned that turning DHS around would take time.

"Child welfare is a very complex set of expectations and strategies," he said in a statement. "A truly effective and lasting turnaround simply cannot occur in a matter of months."

With its $600 million budget, DHS spends more tax money than any other city department.The department spends 85 percent of its money, the bulk of which comes from federal and state sources, on outside contractors. They run programs that include parenting classes, drug treatment and foster care.

About $30 million a year of that 85 percent goes to the providers who watch out for at-risk children at home.

Depending on children's level of risk, social workers may visit as often as twice a week to ensure that medical and schooling needs are met.

Providers in the SCOH program must alert DHS when a client family has a problem and are required to file quarterly progress reports.

Germantown Settlement, which received $462,361 from DHS for at-home services in 2006, is one of the five providers the city suspended after The Inquirer's stories raised questions about contractor oversight.

In a December 2006 review, DHS said Germantown Settlement appeared to "provide minimal social services to families." It often failed to visit the children in its care and had two employees, including a supervisor, who worked full-time jobs for two different SCOH providers at the same time.

In one case, a child with severe tooth decay and other medical problems had not seen a physician in two years. In another case, a teen did not appear to have attended school in two years.

One Germantown Settlement social worker said he tried to visit clients but they weren't available.

Inspectors were skeptical. "It seems unlikely that this situation could happen with such frequency," reviewers wrote.

In three instances where cases were closed, DHS was never notified. One case file contained only two documents. In all, workers at Germantown documented only 70 of 174 required visits during the review period.

According to the review, Emma Cummings-Freeman, vice president of Germantown Settlement, told inspectors that "a ceiling collapsed in the building where the files are housed and files were destroyed because of water damage." When asked - twice - to document the floods, it was not clear in the reviewer's notes that she was able to do so. She said "there were missing documents in other files and that 'damaged' case records might not have been recreated."

Cummings-Freeman declined repeated requests from The Inquirer for interviews.

"The story is what the story is. I can't elaborate," she said yesterday.

In December, when a DHS reviewer asked her about one of the workers who had two full-time jobs, Cummings-Freeman said she had been satisfied with the worker's performance. She was shocked, she said, by the revelation that he was not visiting his families with any regularity or completing required documentation.

Germantown Settlement's glaring failings should not have come as news. In three of the last five evaluations DHS program evaluators gave the company its lowest rating, "problematic." Although Germantown improved at times to "average," it later regressed.

In December 2002, Germantown Settlement failed to meet 21 of the 27 standards DHS had set. Even after submitting a correction plan, the provider made no progress.

"The Germantown Settlement SCOH program is fraught with problems," analyst Valerie C. Mack wrote. "Each subsequent evaluation finds the program performing more poorly than the last."

In February 2003, when DHS sought to suspend new cases for Germantown Settlement, the company's executive director challenged the suggestion, "claiming he had no knowledge of his agency's ongoing problems," the report said.

The reviewer said it appeared Germantown Settlement had no will to improve its SCOH program. "Intake should be closed until the agency demonstrates significant improvement."

A reviewer wrote in 2004 that the provider had "historically demonstrated an inability to provide adequate SCOH services to families."

In a March 2007 review, Germantown met just 54 percent of performance standards.

Nevertheless, Germantown is still caring for as many as 65 vulnerable children. DHS will not allow it to accept new clients, however, until it gets a positive review.

Frank Keel, a spokesman for DHS, wrote in an e-mail, "We don't know why the previous DHS administration did not close intake on Germantown Settlement.

"It could have been for a variety of issues, including capacity. These kinds of situations won't be an issue for this agency now or going forward, as evidenced by the recent disciplinary actions DHS took against providers."

In interviews, DHS officials and other experts acknowledged that the system was designed simply to roll over contracts year after year.

They said they were reluctant to fire providers, even those that were deemed incompetent, for fear of disrupting services to families or losing capacity if more children suddenly needed care, DHS officials said.

"The bench is thin," said Cervone, head of a group that provides free legal assistance to children involved with DHS. "There is not a surplus of providers or workers. So they don't want to lose providers.

He added: "Obviously, that can't be an excuse for tolerating bad performance or poor care."

At least five Philadelphia children, ranging in age from 2 months to 14 years, have died since 2003 in households receiving social-welfare help from DHS contractors.

Because the city refuses to release details of cases, it's unknown whether those contractors might have been able to prevent the deaths.

However, a state review of 80 SCOH cases released this month showed that DHS and its private providers failed to keep children safe in 21 of those cases.

What constitutes keeping a child safe takes volumes of manuals to describe, but evaluations are based on how quickly the department or provider investigated abuse allegations; how well they assessed risk and documented claims, such as taking photographs; and whether they took action to prevent future abuse.

The state evaluation gave DHS's entire $30 million SCOH program a failing grade on all counts.

Part of the problem is that although DHS pays more than a half-billion dollars a year for services from outside companies, it budgets only about $3 million to make sure they perform the work.

Of the more than 1,600 DHS employees, only about 15 evaluate private providers.

That small group reviews not only the 40 SCOH providers, but 250 or so other contractors that perform work for DHS.

DHS auditors spend three to five days randomly sampling case files. Among other checks, the auditors make sure caseworkers have at least a bachelor's degree. Typically, analysts will call a family or DHS caseworkers only if something seems amiss in the records.

Even the association of private providers agreed that the current system of evaluating contractors was flawed.

"Performance standards say nothing about the quality involved. You may have one five-minute contact that is a breakthrough, but that's not reflected in a report." said Bernadette M. Bianchi, executive director of the Pennsylvania Council of Children, Youth and Family Services.

Relying less on paperwork and more on interviews with clients, Evans said, will strengthen the oversight system.

Last year, when former Councilman Michael Nutter proposed legislation requiring all city contracts to be put out for competitive bids, Cheryl Ransom-Garner, then the DHS commissioner, fought for and won an exemption under the law for existing services.

At the time, top DHS officials argued that if private providers were forced to compete there would be a lapse of service to families during the bidding process and the system would collapse.

National experts who have helped other states privatize their child-welfare systems said large cities should solicit bids for contracts and evaluate providers by looking at the results of their work. Child welfare systems should not rely on a review of documents to make sure children are safe.

"Agencies that have put in place sound accountability do not behave that way," said Mark Courtney, who teaches in the School of Social Service Administration at the University of Chicago.

He said one reason cities privatize social services is to make departments more nimble.

"If you don't have a good accountability system that measures outcomes and you're not willing to fire poor performers, then you're not nimble," Courtney said. "You're a hostage."