Introduction
 

We are pleased to provide the twentieth annual State of the Department Report to the Dare County Board of Social Services.

This report provides an overview of the current state of affairs within the Department of Social Services.  It is organized into six sections:  Adult Services, Children’s Services, On Call Services, Economic Services, Family Services and Administrative and Technology.  Within each section, the status of individual programmatic areas is reviewed and strengths and areas of concern identified.  Finally, recommendations are outlined in each area.  These recommendations serve as the basis for unit work plans and budgets.  The report is prepared by a “bottom up” approach; staff has the opportunity for significant input.

The state of the Department is generally good.  Dare County Department of Social Services positively touches the lives of many Dare County citizens.

There are concerns, however. The housing downturn has affected many Dare County families, particularly those with ties to the construction or real estate industry.  Many families struggle to make ends meet in this high cost of living area.  Incompetent adults are exploited.  Children are abused or neglected.  Day care placements are not available.  More and more homeless are being seen.

Like most human services agencies, there is always more to be done at Social Services than can possibly be done.  This report is our attempt to step back from the day-to-day demands and assess our performance.  It is our attempt to find out “where we stand” so that we can chart a course to best meet future demands.  Management and staff feel that this planning exercise is very valuable.  We hope that the Board of Social Services, and others, will find it helpful in understanding the work of the Dare County Department of Social Services.

 Adult Services
 
Overview

The priority services for the Adult Services Unit are receiving and evaluating reports of abuse, neglect, and exploitation of elderly and disabled adults, providing the protective or essential services that are needed, and supporting adults to live as independently as possible in the community or in the least restrictive environment where their needs can be met.  Our social workers continue to collaborate with many public and private entities in an effort to identify, develop, and provide the assistance and support needed.  Caseloads for our six social workers have ranged from around 100% to 166% of the state recommended caseload size for the programs assigned to them.  Workers have shown creativity and professionalism in their work throughout the year.

Eighty-six adult protective services reports were screened in for evaluation during 2007, a 19.5% increase over 2006.  The rate of increase has fortunately slowed from the higher rates we experienced between 2004 and 2006.  Total reports numbered 105 and represent a 25% increase over the previous year.  In almost all of the 19 cases, the individuals who were screened out for protective services received an outreach visit or call with other services being offered to alleviate the concerns about their well-being.  Significant in 2007 were larger numbers of reports concerning developmentally disabled adults who were being abused or neglected, adults so dependent on alcohol or drugs that their self-neglect placed several of them at risk of imminent death, and several incidences of financial exploitation involving large sums of money or valuable property.  In fact, three of those with advanced alcoholism died a few days or weeks after being hospitalized.  The victims of financial exploitation comprised several of the cases in which we filed court petitions.  This action was necessary in order to protect the adult’s remaining assets or to get the assets returned to them.

Overall, our confirmation rate in protective services was 77% for this period.  This figure represents the reports for which we found evidence that the alleged abuse, neglect, or exploitation did in fact occur.  Our substantiation rate was 47% for the same period.  This number represents the reports in which we found the adult to be in need of our intervention and protection because they were unable to act in their own behalf due to physical or mental disability and had no one available to act for them.  These figures compare to 35% confirmed and 19% substantiated for the state as a whole during 2007. The state Division of Aging and Adult Services issued another report in July 2007 which looked at the effectiveness and consistency of adult protective services in the 100 counties of North Carolina .  They started with a premise that, conservatively, 2% of all people age 60 or older will suffer abuse, neglect or exploitation in a given period of time.  They then compared the actual number of reports for each county to that 2% of age 60 and older figure from the county’s population statistics.  Experts in the field of elder abuse had determined that they would expect there to be a substantiation rate of 32% of those reports.  Dare County’s statistics placed us at about 67% of our expected number of reports or 71 of an expected 106.  This figure is deceiving because only people 60 and older were considered in this data and, in Dare County , at least 30% of our reports concern disabled adults between 18 and 60 years of age, making the “expected” figure low.  Our performance did, however, exceed that of almost every other county in the state in this analysis.

The most common interventions in adult protective services include seeking emergency or urgent medical care which can involve hospitalization, facility placement or other residential treatment; locating family members who often live out of the area and many times are in other parts of the country; arranging for in-home services through public or private agencies; and filing court petitions necessary for the department to have legal authority to act on behalf of clients.  Petitions filed include protective services exparte and emergency orders that must be heard by a judge, incompetency hearings to be heard by the clerk of court, and petitions for involuntary commitment to psychiatric or detox and drug treatment facilities. 

Among the petitions filed by our staff this year were several protective orders and twelve petitions for incompetency proceedings.  Our director was appointed interim guardian in eight of those cases and permanent guardian of the person for seven wards.  During 2007, we also lost four wards due to death and one who relocated to Pennsylvania with his family.  As of December 31^st, we had ten adult wards.  Our social workers were successful in getting Albemarle Mental Health Center appointed guardian for two young adult clients whose primary disability was mental illness or a combination of mental illness and a developmental delay.  Both clients required residential placement in homes licensed under the mental health laws.  All public agent guardians have the same obligation to understand their responsibilities and to act to ensure the well-being of their wards.

Our department faced several challenges in serving high risk, frail adults.  It is important that court and legal personnel, law enforcement, medical and mental health professionals be committed to recognizing the special needs of this segment of the community.  These adults have urgent or emergency needs for care and supervision that can only by met by improving the community resources that are available.  It is also important that we make an efficient and effective use of our social workers in these cases.  Inherent conflicts have occurred when confused, delusional older adults, sometimes with injuries, are taken to the hospital by ambulance but fail to meet the normal standard of needing acute care that is required for admission.  When these folks are returned home alone with no ability for self care, the risk of further injury or permanent harm can be alarming.  They are often unable to comply with medication instructions, get adequate nutrition, or recognize that their environment has become unsafe.  It will take the combined and creative effort of many groups in the community if we are to solve these problems.  The Elder Abuse Collaborative formed in 2006 has continued to bring much needed attention to these needs and has succeeded in several accomplishments.  With financial assistance from the Aging Administration at the Albemarle Commission, brochures describing the mission and work of the Collaborative, posters informing the public and professionals about elder abuse and its victims, and bookmarks for wide distribution with a similar message were printed and distributed.  Our next project will be to have informational meetings with banks and financial institutions in the county.  We are hoping to improve their ability to detect fraud and misuse of accounts belonging to the elderly, and provide information on the legal mandate to make protective service reports when appropriate.

The Adult Services staff provided case management services to dozens of other clients in need of economic support and stability, assistance to meet health and mental health needs, placement in assisted living or nursing homes, and other supportive services.  One program that has proven to be particularly effective is the Special Assistance In-Home program.  It is available to Medicaid eligible adults who are at risk of placement in a domiciliary facility and for whom monthly financial assistance can help guarantee their essential needs can be met.  At the beginning of 2007, Dare County had 17 slots for this program.  During the year, we requested and were awarded an additional seven slots. 

The Community Alternatives Program for Disabled Adults, a Medicaid program that assists adults in need of nursing home level of care who have family support and who wish to remain home, has struggled to fill the sixteen slots available for our county.  Estate recovery policy and transfer of assets policy also apply to clients of this program.  This is certainly a factor in discouraging participation for some individuals who would otherwise benefit.

One hundred fifty-three clients received 31,515 hours of in-home aide services through our program this year.  While the vast majority of these hours were provided by certified nurse aides employed by our department, 14 clients were served through contracts with two licensed home care agencies, Visiting Angels of the Outer Banks and with North Care out of Greenville .  They provided 2,676 hours at a cost of $41,728.00.  We provide contracted services when an aide is urgently needed such as in the case of protective service cases or if delaying the assistance could result in harm to a client. Clients of in-home services ranged in age from 18 to 102 during this period.  Very young clients of the program generally have serious developmental disabilities or have suffered devastating injuries or illnesses.  The vast majority of clients are aged.  Almost a third during this period were 85 years old or older. Consistent with prior years, the greater proportion of our aide services were provided to clients in need of personal care assistance, medical monitoring, and supervision for safety.  A total of 56 new clients were approved for in-home aide services and began receiving the service during this period, while 47 people were terminated from the program. The large percentage of clients who were served through the end of their lives or until placement in a facility became necessary indicates that we are meeting our mission of enabling those at risk to remain at home as long as they can safely do so. 

The cost of in-home aide services is covered by three sources:  Medicaid, the Home and Community Care Block Grant administered by the Division of Aging, and some county funds.  Our grant from the Home and Community Care Block Grant increased by about 17% for the most recent fiscal year to $117,6421.  With the 10 percent county match, this source of revenue totaled $129,406.  Medicaid revenues for the months covered by this report were $205,210.63, a 3.5% increase over last year.  Voluntary contributions made by clients to the program totaled $11,531 during the period.  Clients whose aide services are paid for through either the Home and Community Block Grant or through county funds are asked to make a small contribution toward the cost of the service based on hours received and on their income.  They cannot be required to contribute and the amount and scope of services that they receive cannot be affected if they are unable or choose not to contribute. We are very proud that Department of Social Services clients voluntarily give such a significant amount  This helps to defray the cost of their services and also enables more people in need to have aide services.

We continued to enjoy a low turnover rate of staff working with the in-home services program.  According to NC Division of Health Service Regulation statistics, the state turnover rate in 2006 for nurse aides working in nursing facilities was 111%, the rate for adult care or assisted living homes was 117%, and the rate for home care agencies like ours was 50%.  We had one resignation and no terminations during the report period among our aide staff giving us a turnover rate of only 4%.  We had 0% turnover among administrative, supervisory, and social work positions attached to in-home services this year. This factor enhances the knowledge and level of skill of staff at all positions primarily because they are staying in the job long enough to learn it well.

Our in-home aide supervisor, Sue Hewitt, made 275 supervisory visits during the report period.  Her responsibilities also include interviewing potential aides, making hiring decisions, orientation and training for the aides, scheduling coverage for clients and arranging for backup when necessary, facilitating communication between the aide staff and social workers and billing clerk, and ensuring that records are kept to the standard required by licensure.  Louise Gray, our nurse supervisor, made a total of 338 home visits for assessment or supervisory purposes to 79 of the in-home services clients. State licensure rules require that a registered nurse do the physical assessment and provide supervision for the nurse aides at least once every three months if any personal care or medical monitoring is being performed for the client.

Two of the goals that we chose last year to enhance our program involved managing the size of the waiting list and tracking the length of time that applicants have to wait for in-home aide services after requesting it.  We analyzed this data from our inquiry lists and current case files as part of our annual goals report in July.  We hoped to keep the waiting list no larger than 33% of the actual number served in the most recent fiscal year and found that we were at 29%.  We also had a goal of beginning aide services for every eligible client within six months of their request.  Seventy-two percent of clients requesting the services began receiving it in six months or less in the 2006-07 fiscal year. Adult Protective Services clients are always given priority and generally begin receiving help within a week following substantiation of the case. 

As in past years, the social workers assigned in-home cases worked dependably and innovatively to ensure that all needed and appropriate services were provided to these high risk clients. In addition to meeting the licensure and funding requirements for in-depth initial and annual assessments, frequent case reviews, and development of complex service plans and plans of care for the aides to follow, the workers all backed up the protective service workers by taking and making reports, assisting with investigations when needed, preparing for and testifying in court proceedings, and, in every way providing professional social work services.   All adult workers must learn and understand complex medical and psychiatric terminology.  They must do the detective work necessary to determine if clients are complying with numerous medication orders and know to watch for signs of problems that non-compliance would cause.  They must understand and assist clients with Medicare, Medicaid, and other insurance claims and other financial matters.  They also must deal with sometimes frightened, angry and uncooperative clients and families who are overwhelmed by the problems they are facing.  Their work is a vital part of our program.

Because so many of our clients have serious medical problems requiring frequent doctor visits, special treatments and therapies, our social workers have to devote many long hours and days making sure that appointments are kept and that physician instructions are understood.  Often, these clients are too physically or mentally frail to make use of the county transportation program because they do not qualify to ride on the vans without supervision. Many of these appointments are in the Norfolk , Virginia area or Greenville where many specialists are located. For many, no family, friend, or other acquaintance can be found so that the social worker must provide the transportation, assistance, and follow up that more fortunate people receive from family support.  We experienced a large number of these situations in 2007 and the time out of the office assisting clients in this way makes it difficult for the workers to meet the other requirements of their positions. 

 Identified Strengths

A.       We have an experienced and dedicated staff at all positions with almost no turnover.  They work cooperatively and well for the benefit of clients and the department.

B.     We will soon be able to offer more consistent services on Hatteras Island when our new social work position begins there in July 2008.

C.     Workers in the Adult Services Unit have been very involved in recognizing and responding to changing needs in the community, both as part of the job and in their personal lives.

D.     The financial resources available to the unit have been used responsibly and well to enhance the safety and stability of adults at risk in the community.

E.     The level of professional and public awareness of elder abuse has improved over the year due largely to the formation of the Dare County Elder Abuse Collaborative.

Areas of Concern

A.       The in-home aide supervisor and registered nurse carry enormous responsibilities and relief is needed.  Supervising very specific tasks for 25 employees who all work off-site is demanding and requires constant attention to detail.  The consequences if errors are made by in-home aides can be very serious.

B.     Frail clients in need of constant supervision are frequently left alone or sent home alone because no transitional service is available to help them in urgent or emergency situations.  The department has no capacity to provide care 24 hours a day, 7 days a week no matter how badly it is needed. There are few private home care agencies available even when the cost can be covered.

C.     The problems of advanced alcoholism and drug abuse permeate many adult protective services cases, either on the part of the client who is self-neglecting or a caregiver who is not providing adequate care for someone.  We learn of many of these cases when it is too late to help them.

D.     While respecting the need to keep customer information confidential, a way must be found to inform managers and employees of financial institutions about the legal mandate to report suspected exploitation against disabled adults and to work effectively with them to protect these individuals.

E.     Social workers do not have time to spend entire days taking their clients to medical appointments but the county transportation program is not an alternative for many of them due to frailty, mental confusion, and lack of family support

Recommendations

A.       Create a second in-home aide supervisor position. 

B.     Collaborate with the hospital and emergency room personnel, nursing home and assisted living facility in the county, EMS , and all other public and private home care agencies to find a way to provide sick elderly and disabled adults with the supervision they need, particularly in urgent or emergency circumstances.  Perhaps the addition of swing beds at the hospital could be considered.

C.     Continue stressing public information regarding the needs of disabled adults and support the further development of a variety of substance abuse services to be available locally.

D.     Develop a relationship between the Elder Abuse Collaborative and area financial institutions that will enhance the sharing of knowledge concerning financial exploitation and fraud against elders.

E.     Create a transportation aide position for the department who would be knowledgeable and available to take over many of the full day medical trips for clients and relieve the social workers to fulfill their other responsibilities.

 
Children's Services
 
Overview

Children’s Services includes Child Protective Services, Case Management, Foster Care and Adoptions.  State performance indicators show that, overall, Dare County is doing a good job of protecting children, working with families, and finding permanence for children that are unable to remain in their biological homes.  The unit experienced three vacancies during the year.  Two were due to the high cost of housing in the county and the third occurred when a new hire was not able to meet performance requirements.  Two staff members have had medical issues that required extended or frequent absences causing further strain on the remaining workers.  Vacancies have been filled with social workers with strong skills and the unit has been able to retain its sense of cohesiveness and professionalism.

The Multiple Response System was implemented in March 2006 with few difficulties.  This reform aims to increase family involvement in assessment and planning when addressing child welfare concerns.  In calendar year 2007 there were 100 investigative assessments and 151 family assessments involving 485 children.  Investigative assessments follow the original child protective services protocol, in that children are seen first, without parental knowledge.  Investigations are now done only in cases of alleged serious neglect or abuse.  This would include such things as domestic violence involving injury and drug sales where a child resides in the home and drugs or weapons are accessible to the child.  A family assessment requires notification to the family of the report, and appointments are normally set with the whole family if possible.  This approach is more family centered as compared to forensic investigations.

This system also brought about the creation of the Responsible Individuals List.  The Responsible Individual List is used to identify parents, caretakers, or custodians that have been identified as perpetrators in all substantiated cases of abuse or serious neglect using the investigative assessment response.  Information from this list is only available to authorized persons for the sole purpose of determining current or prospective employment.  Thirty five individuals have been placed on this list, and four individuals have requested review by the Director.  If the Director receives a request for expunction, the case is reviewed by him to determine if there is relevant evidence a reasonable mind would accept as adequate to support the case decision.  A request may also be made to the District Attorney for the First Judicial District, or an individual may file a petition for expunction in the District Court.  The decision to place these four individuals on the Responsible Individual List was upheld in each case by the Director, and no requests were made to the District Attorney or the District Court.

During the year 2007 averages of 22 cases per month were served by CPS In-Home Services, previously referred to as case management.  The primary goal is to provide involuntary child protective services that are designed to ensure the children’s safety, permanence and well-being, while helping the parent/caretaker to learn more effective parenting practices.  As part of the Multiple Response process and family centered practice, interventions focus on accessing the family’s immediate and extended community through needs assessment, resource identification and service delivery.  A Child and Family Team is a group of persons identified by and with the family who are committed to the child and family, and are invested in helping them change.  These meetings are held frequently to develop family case plans, anytime a decision needs to be made that impacts the family, if there is reason to believe that there is concern about a child’s health, safety or permanence, prior to the child coming into the legal custody of the agency or prior to reunification, and if the child is in the legal custody of the agency.  All Child and Family Team meetings conducted while the case has a high or intensive risk rating have non-involved trained facilitators.  Currently the agency contracts with a local therapist to serve in this capacity.

There are 48 youths in foster care, four more than last year this time.  In 2007, the number of children in foster care has averaged 50, approximately ten more than the average in 2005 and 2006.  This increase has been the result of the agency losing state funding which had been provided for those years through the IV-E Waiver Demonstration Project.  When they were available, these funds were used to provide additional services for families, resulting in improved family functioning and reduced risk to children, so that they could be safely maintained in their own homes and included funding for guardianship subsidy to assist in achieving permanence for older children.

Of the children in foster care, five are placed with their parents and we anticipate that legal custody will be returned to them in the near future.  Fourteen other children are placed with relatives and five are older children in therapeutic placement, due to their special needs.  Ten of the children in foster care are placed in eight local foster homes.  Three of the youth in foster care are over the age of eighteen, and are in agency custody voluntarily. We are assisting one in her efforts to graduate from high school, and the other two young adults are currently attending community college.  One of these youths is an undocumented alien, so the agency is very limited as to what can be provided to him financially.

Of the 45 children under age eighteen, 17 have been in agency custody for over one year.  Of these, five children are in adoptive placements and their adoptions will soon be finalized.  One child, although recently freed for adoption when the parent’s appeal resulted in the Court of Appeals affirming our Court’s decision to terminate parental rights, is not yet in an adoptive placement due to his significant behavioral and mental health issues.  An appropriate, adoptive family is being sought for him currently.  Four of the five teenage children in therapeutic placement have been in foster care over one year, primarily due to the extent of their behavioral problems and mental health issues which prevent them from being adoptable.

There are two teenagers in foster care currently who are placed with a relative who wishes to become their legal guardian, however, this has not been facilitated as of yet because of the lack of financial support for these youth, after they leave foster care.

Currently, there are 14 licensed foster homes and two families in the licensing process.  The agency has continued to contract with a former foster/adoptive parent to recruit, train and license families and this continues to go well.  A senior social worker has continued to work with our foster families, in addition to her duties as our adoption social worker.  She has been able to provide more training and support to these families and plans to expand the training opportunities this year.

The Wright Place for Youth, the county group home operated by the Methodist Home for Children, provides care to children in the custody of the county, and, on a smaller scale, neighboring counties.  Twenty-one children, seventeen from Dare and four from other counties, were placed in the home during 2007.  Although it has been very difficult for Methodist Home to maintain stable staff in the last several years, the Wright Place is fully staffed at this time.

In 2007, thirteen children left foster care through adoptions that the agency facilitated.  Two of these children are unique in that one is a seventeen year old child who had spent most of her childhood in foster care in Maryland before locating here with her parent, and the other is a seriously disabled child who had been in foster care here for years.

Four children left foster care in 2007, when they were successfully reunified with their parents and two others left when they were placed in the guardianship of relatives.  Two children chose to leave foster care after their eighteenth birthdays.

The Special Children Adoption Fund is a vital resource in the placement of special needs children.  The money is used to enhance adoption programs and secure permanent homes for hard to place children.  A portion of the money of the money was used this past year to cosponsor a conference with the North Carolina Family Based Services Association.  The featured speaker, Dr. Bryan Post, is a specialist in the treatment of attachment and trauma in children and families.  The conference was attended by foster families, therapist, teachers and agency staff.

The Special Children Adoption Incentive fund, a second and separate fund, was abruptly stopped for all new applications in August 2007.  The General Assembly had allocated the funds to financially support the adoption of children that had a need for daily supervision due to behavioral and emotional diagnosis or, children with a serious medical condition.  This money allowed adoptive parents to provide 24 hour a day care for the children or to pay a provider.  All children who are currently funded will be covered until their 18^th birthday.  The agency has several foster adoptive parents with special needs children that would have been eligible for these funds, and this will create a financial burden for these families. The lack of the incentive will make adoption more difficult for other qualified children in the future.

In December 2007, the agency was notified of a new law, effective January 1, 2008 that allows for licensed child placing agencies to act as confidential intermediaries between adult adoptees, adult lineal descendants of a deceased adoptee, parents of adoptees under the age of 21, and biological parents.  This program will be adopted in 2008 by Dare County DSS and will serve individuals that have been adopted through this agency.

The Methodist Home for Children provides state-funded Intensive Family Preservation Services to families in our region.  During 2007, eight families and twelve children were served.  There were many other families with significant issues related to substance abuse and domestic violence where these services were needed, however, they were not provided the services through the state’s program.  There is one person employed to do this work for four counties and only a small number of families needing this valuable service actually received it.

North Carolina completed the Federal Child and Family Services Review in the spring of 2007.  The State was found to be in substantial conformity in 5 of 11 systemic and outcome areas.  A Program Improvement Plan was required to address each area determined not to be in substantial conformity.  As a result of lessons learned during the federal review, the Division of Family Support and Child Welfare made the decision to suspend individual county reviews June 20, 2007 to allow time for completion of revisions of the North Carolina review instrument and process.  Although the review tool was one of the systemic factors found to be in compliance there was concern that the State’s ratings for the majority of areas differed considerably from the Federal Review case review findings.  Changes were made to the review instrument that included significant changes in the emphasis placed on contacting and maintaining contact with fathers and paternal relatives as resources for children, the number of social work contacts that will be required with families based on the risk level, allowing no exceptions in counting repeat maltreatment in a case as an area needing improvement and more emphasis placed on Child and Family Team meetings in the Case Planning process.  A training curriculum which details the changes in the rating system will become available, however counties scheduled for review in February 2008 – April 2008 will be given priority.  It is anticipated that with these revisions, compliance in all areas will be difficult to achieve.

The lack of resources for parent training, family preservation services and substance abuse treatment in our area has continued to be a significant concern as it related to meeting needs of high risk families.  The funding provided through the State IV-E Waiver Demonstration project made it possible for the agency to implement programs and services to meet these needs in 2005 and 2006, resulting in fewer children entering foster care.  Since this funding has been terminated because the state was not able to achieve cost neutrality, we are seeing an increase in the number of children entering foster care.

Funding to allow the agency to provide guardianship subsidy for a limited number of older children who have the opportunity to leave foster care and experience permanence through guardianship with a relative is needed.  Funding for family preservation services is also needed in order to maintain children safely in the homes while addressing very serious issues in high risk families.

 Identified Strengths

1. The staff is very dedicated to protecting children and are dependable, diligent and hardworking
2. Children’s services staff have a good working relationship with school personnel, law enforcement, the local domestic violence program and local mental health providers.
3. The legal counsel for the agency is very experienced in children’s services.
4. The social worker in the Family Services unit currently providing services for high risk cases has been effective in preventing some from becoming child protective services cases and is a valuable resource for families who no longer require child protective services, but need support and advocacy.

Areas of Concern

1. Many serious cases involve substance abuse.  There are few local resources to assist substance abusing families.  Rehabilitation clinics and aftercare are not available in this area currently and there continue to be long waiting lists.  The process for making referrals for substance abuse evaluation or crisis and the response is frustrating and inconsistent.
2. A significant number of children left foster care in 2007; however, the backlog of children in care over twelve months remains a significant challenge for us.
3. Demands continue to be placed on the agency to assist families in dealing with very aggressive behavior of children with unmet mental health needs, when few interventions are provided by other agencies.
4. Currently there are no additional funds for special needs children that are cleared for adoption.

Recommendations

1. Continue to participate in community efforts to improve substance abuse treatment and meet other needs of the families we serve;
2. Encourage political support for the addition of a family court in this district;
3. Find a way to off-set the loss of IV-E Waiver funds to provide in home family preservation services to more high risk families to prevent the removal of children from the family home, provide facilitation services for Child and Family Team meetings and guardianship subsidy to make it possible for a small number of older children to leave foster care and achieve permanence, when financial need is identified as a barrier.
4. Continue to support the Dare County initiative to provide substance abuse services.
5. Continue to advocate for legislative appropriation of additional funds for Special Needs Adoption Incentive Fund.

On Call Services Unit
 

Overview

On Call Unit was formed in February 2002 and currently has four social workers and five supervisors.  The unit provides after hours coverage for emergencies for the Department, to include child, family and emergency services reports.  Unit members are scheduled on a rotation basis, are available after hours, holidays and weekends, and are dispatched through Dare Central.

The unit continues to function well.  Decisions concerning serious child or adult abuse or neglect are handled by the respective units and all petitions and court proceedings are also handled by the appropriate staff.  New call tracking procedures have recently been instituted and additional training on Adult Protective Services is scheduled.  There have been no significant problems within the unit and everyone seems comfortable with the process.

Identified Strengths

1. The unit is composed of experienced staff and there have been few changes in workers.
2. The monetary compensation is good and most of the social workers are in need of additional income.

Area of Concern

1. There are currently only four child protective services social workers that staff on call.  As the numbers of Adult Protective Services reports rise and more calls are received concerning financial/emergency services in this depressed economy, it would be beneficial to have workers from other units volunteer to serve.

Recommendations

1. Continue to provide training as needed.
2. Conduct recruitment in the spring and encourage other workers to apply.

Economic Services
 

Overview  

Economic Services Unit is responsible for assessing an individual/family’s need for temporary assistance offered by one or more public assistance programs administered by social services.  This frequently involves outside contacts to other agencies to assist the individual/family in accessing all potential benefits available.  Dare County is unique in their approach to this process in that staff assigned to this unit are knowledgeable in all program areas.  This is a more customer friendly approach allowing an individual/family to share their situation with one expert caseworker to evaluate their situation, completing necessary paperwork for the appropriate program(s).

The programs individual/families are assessed for include; Work First Family Assistance, Benefit Diversion Assistance, Food and Nutrition Services (formerly known as food stamps), Medicaid, North Carolina Health Choice and Special Assistance. These are means tested programs that assist with the prevention of a crisis or provide nutritional, medical or financial support to remedy a situation when a family is already in crisis.  Work First Family Assistance provides temporary cash assistance and Medicaid to qualifying families with children age 18 and younger.  Benefit Diversion Assistance is a short-term money payment intended to assist families that are temporarily out of work.  Food and Nutrition Services help low income individuals/families purchase food.  Medicaid provides individuals/families with a means to access needed health care.  North Carolina Health Choice provides health coverage for children under age 19 whose parental countable income is at or below 200% of the federal poverty level.  Special Assistance provides assistance to persons living in adult care homes (rest homes) that have a financial need and are age 65 or older or between the ages of 18 and 65 and meet the social security definition of disabled or blind. 

There were a total of 3,862 applications received during calendar year 2007, a 1% decrease from the 3,891 applications received in 2006. When comparing August through December 2006 and 2007, it shows a rise in requests for services from 1,641 applications received to 1,775 in 2007 or an 8% increase, a clear indicator of a slow local economy.  

Individual case situations appear to be more complex with requests for services in multiple programs by those seeking assistance.  By far the largest number of applications received is for Medicaid. Uninsured individuals facing terminal illnesses or decreased income create a ripple effect of need within their family and our community.  Often the individual in medical need is a source of family income which is now diminished. The lengthy wait for Social Security Disability or Supplemental Security Income can be financially and emotionally devastating for these families.  Agency staff offer assistance in a knowledgeable and compassionate manner most often going above and beyond program requirements for the best possible outcome.

The agency continues to be involved with the Community Care Clinic of Dare, a free health clinic that opened in Dare County in May 2005.  Since the opening of the clinic in 2005, staff have made many referrals for assistance relating to needed prescription medications.  In 2006 the agency spent $16, 843 on prescription medications; this decreased to $8,348 in 2007, proving the benefits of an excellent working relationship with the Community Care Clinic of Dare.

A more detailed overview by program follows.

Work First Family Assistance

Work First Family Assistance provides temporary cash assistance to families who are either in a crisis or have the potential to be in crisis.  In addition to cash assistance, eligible families receive Medicaid and frequently receive Food and Nutrition Services.  Those families with a child over the age of one are required to work with the employment social worker to develop a plan of action that will remedy their situation, allowing them to become self-supporting.  The application caseworker completes all the necessary paperwork including an appointment time for the employment social work staff, and if needed registers the applicant for work with the Employment Security Commission.  Case workers registered 76 individuals for work in calendar year 2007; this is a 28% decrease from the 106 individuals registered in 2006.  In part it is believed that some of this is due to the increase in Benefit Diversion Assistance in 2007 along with exempt individuals. 

There was little change in requests for Work First Family Assistance during 2007 when 177 applications were completed. This is an increase of 2% from 174 applications for the same time period in 2006. Overall participation in the Work First program decreased when comparing calendar year 2007 to calendar year 2006.  An average of 44 households received cash assistance in calendar year 2007, a 11.5% decrease from the average of 50 households receiving assistance in calendar year 2006. 

The number of Work First adult households increased by 11.5% when comparing calendar year 2007 to calendar year 2006, with a monthly average of 18 households in 2007 and 16 households in 2006.  Work First child only cases have decreased by 15% when comparing calendar year 2007 to calendar year 2006, with a monthly average of 27 in 2007 compared to 32 cases in 2006.  Total expenditures for Work First cash assistance averaged $9,530 during the 2007 calendar year, a 10% decrease from the monthly average of $10,580 during calendar year 2006.

The number of Work First cases has remained constant over the past five years, averaging 45 cases.  Case numbers ranged from an average of 41 cases to an average of 50 cases during the 2002 through 2006 calendar years.  As new applications are approved, the same number of cases are being terminated due to employment and being over income, approval for disability income, or for failure to comply with program requirements.

Work First Cases over Time

Benefit Diversion Assistance allows for three months of cash assistance in the form of a lump sum payment.  The family’s situation is evaluated to determine if short term assistance will help keep a family from a crisis situation.   There was a 23% increase with 30 cases approved for Benefit Diversion Assistance during 2007 compared to 24 cases approved in 2006. 

Food and Nutrition Services

Food and Nutrition Services (formerly referred to as food stamps) helps individuals and families increase their purchasing power to provide more nutritious meals, promoting better health.  Individuals or families must meet income guidelines (at or below 130% of the Federal Poverty Level), and asset, citizenship and work requirements in order to be eligible to participate.  Individuals are now able to access these benefits through the newly designed state food stamp application. The application is designed to allow individuals and families to apply through the mail and complete a review by phone.  Applications have been placed in various locations throughout the county and can be requested by phone.  There was a significant increase in food stamp mail-in applications with the agency receiving 138 in 2007; a 2,760% increase from the 5 applications received in 2006.  While in theory this is a wonderful way to reach individuals, policy changes have not occurred to support this method of applying for benefits often making already rigid time restraints almost impossible to meet.  Good communication among the agency’s units is essential to the success of meeting state time standards.

There were a total of 1,015 applications received for Food and Nutrition Services during calendar year 2007.  This is a 9% increase from the 930 applications received during in 2006.  Out of the 1,015 applications received in 2007, 11.5% were mail-in applications, which numbered 130.  There were a total of 367 new applications taken for first time applicants during 2007.  This is a 15% increase from 319 taken during 2006. The monthly average number of applications processed in the 2007 calendar year was 79, a 5% increase from the 75 average applications processed in 2006.  The monthly average percentage of applications being denied in calendar years 2007 and 2006 remained constant at 25%.  The monthly average number of households receiving food assistance increased from 486 to 551 over this period, an increase of 13.5%.  The monthly average number of individuals participating in the food and nutrition services program was 1,152 in 2007, a 16.5% increase from the monthly average of 989 individuals in calendar year 2006.   Average expenditures per month in calendar year 2007 were $105,897, compared to $86,520 in the same time frame in 2006, an increase of 22%.

   Food and Nutrition Services Activity

Family Medicaid and North Carolina Health Choice for Children

Family Medicaid programs allow children, families and pregnant women to access emergency and routine preventative health care.  The family Medicaid programs have become increasingly complex to administer.  Policy changes resulting from the Deficit Reduction Act continue to be the most cumbersome to deal with when interviewing and processing applications for medical assistance.  The Deficit Reduction Act of 2005 mandated, effective September 1, 2006, all applicants for Medicaid must provide proof of citizenship and identity.  In the past, proof of citizenship was required only if the individual’s statement was questionable.  This policy has little or no impact on undocumented aliens as they will remain only eligible for short term Medicaid through emergency services, providing all other elements of eligibility are met, i.e. income and assets if applicable.  It has caused delays in benefits reaching otherwise eligible individuals and families while awaiting an acceptable document of citizenship.  Since Dare County ’s hospital is so new, most birth records are located out of county. During  the January through December 2007 time period, the agency has spent $2,572 in fees for birth certificates.  Caseworkers throughout the agency continue to do outstanding work assisting individuals in obtaining this needed information.   

Since the addition of the Medicaid Family Planning waiver in October of 2005, we have enrolled 146 individuals, with an additional 67 individuals in 2007.  This program targets women ages 19 through 55 and men ages 19 through 60 with income at or below 185% of the Federal Poverty Level. Covered services are limited to birth control methods and routine exams related to family planning. If an individual is enrolled in this program and has a catastrophic need during the time they receive benefits through the Family Planning Waiver, they will not be eligible to receive more extensive