.

Arizona Citizen
Review Panel

THIRD ANNUAL REPORT
DECEMBER 2001

Arizona Department of Health Services
Community and Family Health Services

To obtain further information, contact:
Susan Newberry
Citizen Review Panel
Arizona Department of Health Services
2927 North 35th Avenue
Phoenix, AZ 85017
Phone: (602) 542-1875
Fax: (602) 542-1843
E-mail: snewber@hs.state.az.us
This publication can be made available in alternative format.
Please contact the Citizen Review Panel Program at (602) 542-1875 (voice) or
call 1-800-367-8939 (TDD).

ARIZONA’S CITIZEN REVIEW PANEL
THIRD ANNUAL REPORT
December 2001
Program Background and Purpose
Arizona’s Citizen Review Panel Program was established in response to the 1996
amendment to the Child Abuse Prevention and Treatment Act requiring states to
develop and establish Citizen Review Panels as oversight to the states’ child protective
services systems. The purpose of this program is to develop recommendations for
improvement of child protective services through independent, unbiased reviews by
Panels composed of citizens, social service, legal, medical, education and mental
health professionals in Arizona. The creation of the Citizen Review Panel Program is
an acknowledgment that protection of our children is the responsibility of the entire
community, not a single agency. As such, the child protection system is the interaction
of numerous agencies and individuals. While the primary focus of oversight will be the
Arizona Department of Economic Security/Division of Children, Youth and Families
(ADES/DCYF), the Citizen Review Panels shall take into consideration the impact of
these other entities and assess whether they support or hinder the state’s efforts to
protect children from abuse and neglect. The entire community has a stake in
protecting the safety of its children.

Program Structure
The Arizona Department of Health Services (ADHS), through an interagency service
agreement with ADES, administers Arizona’s Citizen Review Panel Program. During
the planning stages it was determined that o
l cation of this program outside of ADES
would be critical to achieve the independence necessary for an effective, objective
program. The Citizen Review Panel Program Manager provides administrative support
and oversees the operation and organization of the program at the state level.
Arizona maintains three Panels, which are located in Maricopa, Pima, and Yavapai
counties. Each Panel meets at least once a quarter and is responsible for review of
Child Protective Services’ statewide policies, local procedures, pertinent data sources
and individual case records to determine compliance with CAPTA requirements and the
State Plan. The State Citizen Review Panel, located in Maricopa County, serves a dual
purpose of assessment of Child Protective Services and oversight of the local Citizen
Review Panels.

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Progress On Implementation Of Prior Year Recommendations
The following recommendations for improvement in the Child Protective Services
system were identified in the 2000 Citizen Review Panel Report:
•

Recommendation: Expand the child abuse hotline cue questions to identify
language barriers in all household members.
Progress: Cue questions used by the child abuse hotline now include identification
of language barriers in all household members.

•

Recommendation:
management staff.

Increase

efforts

to

recruit

and

retain

bilingual

case

Progress: Efforts to increase recruitment of bilingual staff include advertisement in
urban and rural newspapers, and minority publications, such as The Arizona
Informant and Saludos Hispanos. Job announcements are included on various
Internet web sites including the New Social Worker, the National Association of
Social Workers, and university sites.
•

Recommendation: Develop policies on medical neglect investigations, to include
medical consultation in all reports of medical neglect with moderate or high risk.
Progress: Policy now directs case managers to obtain consultation with a
physician, preferably with expertise in child maltreatment, in cases of medical
neglect with moderate or high risk. The agency is researching availability of
medical consultants throughout all areas of the state and is pursuing expansion of
such resources.

•

Recommendation: Obtain autopsy results prior to entering a determination of the
investigation findings involving a child fatality.
Progress: Child death reports now require autopsy results and review by the
Program Administrator prior to final closure.

•

Recommendation:
Increase funding for prevention programs and alternative
response programs such as Family Builders, Family Preservation and Healthy
Families.
Progress: Family Builders was expanded statewide during this past year.

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Panel Activities
In order to evaluate the extent to which ADES/DCYF is effectively discharging their child
protection responsibilities, the Panels held regular meetings, reviewed the State Plan,
completed case record reviews, examined agency policies and procedures, and
reviewed the Child Protective Services appeal process. Quarterly meetings were held
with DCYF administrators to advise the agency of Panel findings and to discuss plans or
actions taken by the agency to implement the Panel’s recommendations.
The development stage of Arizona’s Citizen Review Panel Program is complete and the
three Panels are fully operational. As a result, the Panels were able to focus more fully
on review of Child Protective Services in Arizona. Recruitment of additional members
continued during this reporting period to assure multidisciplinary representation and to
address vacancies.
Each Panel met on a more frequent basis than the quarterly requirement. The Pima
County Panel met on five occasions; the Yavapai County Panel met on seven
occasions; and the State Panel met on six occasions.
During this reporting period, training was provided to Panel members on the Child
Protective Services appeal process and on Arizona’s Comprehensive Medical and
Dental Program, which is the health care program for children in foster care.
Arizona’s Citizen Review Panels reviewed 18 cases during this reporting period. Case
record reviews primarily focused on investigations by Child Protective Services of
fatalities, near fatalities, other high-risk maltreatment, and investigations resulting in
appeals of proposed substantiated findings. Of these 18 cases, the State Panel
completed six record reviews, the Pima County Panel completed five record reviews
and the Yavapai County Panel completed seven record reviews.

Case Record Review Findings
Panels identified family risk factors in each review. Cases reviewed revealed the most
frequent categories of risk factors included lack of parenting skills, lack of adequate
resources (financial, childcare, housing), and parental substance abuse. The following
is a comprehensive list of identified risk factors:
•
•
•
•
•
•
•

Lack of parenting skills - 17 cases
Lack of resources - 11 cases
Prior Child Protective Services reports - 11 cases
Substance abuse - 10 cases
Lack of anger control - 9 cases
Mental health issues - 7 cases
Lack of motivation to provide a safe environment- 7 cases
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•
•
•
•
•

Parental violence outside home - 6 cases
Domestic violence - 5 cases
Disability of parent - 4 cases
Prior severance/dependency of children - 3 cases
Teen parent - 2 cases

Case record reviews consisted of the assessment of specific activities by Child
Protective Services during the initial stages of involvement with the families. These
stages included Intake/Screening, Investigation, Crisis Intervention, and Case
Determination. In addition to the agency activities, the Panels explored community
involvement with each case. An established form is completed in each record review
and the results are maintained in a database.
The Intake/Screening Stage involves activities performed by the Child Protective
Services Child Abuse Hotline. Activities include gathering enough information to
determine if a report of suspected child maltreatment requires investigation or
assessment by Child Protective Services or Family Builders, the severity of the
allegation and how quickly an initial response must be made to ensure the safety of the
child victim. Record reviews identified this stage as a strength in the child protection
system. The Panels felt that risk levels, response time and maltreatment categories
were appropriately assigned in 17 out of the 18 cases reviewed and all reports were
assigned for investigation within required time frames.
The Investigation Stage involves gathering enough information to assess the child’s
immediate safety needs and to determine whether a reported or disclosed incident of
maltreatment occurred. Activities reviewed in this stage were determined to comply
with agency policy in the majority of cases reviewed. Investigations were initiated and
completed within established time frames in 16 of the cases reviewed.
The
investigations were determined to be thorough and accurate, confidentiality of the
reporting source was protected and appropriate steps were taken to reduce trauma to
the child in the majority of cases. Six cases were considered to not reflect compliance
with agency policy. Areas of concern in these cases primarily involved inadequate
documentation of activities by the investigative case manager and lack of required
interviews.
The Crisis Intervention Stage involves assuring the safety of the child, including the
decision of whether the child could safely remain in the home or if emergency removal
was necessary. Panels found that in all cases, where indicated, safety assessments
were completed; relatives were considered as a placement resource; and judicial
oversight was timely and provided for all parties. In 14 cases, Panels concluded that
the decisions regarding emergency placements were based on adequate criteria. In
four cases, the Panels concluded that the investigation should have resulted in the
emergency placement of the child, or that the investigation was incomplete. In 14
cases, Panels determined that appropriate services were offered. In two cases, there
was no documentation that services were offered. In two cases, services that were

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offered did not address identified needs such as domestic violence, mental health and
substance abuse.
The Determination Stage refers to the process of classifying a case as substantiated
or unsubstantiated based on information collected and analyzed during investigation
and assessment. The Panel found that in 14 cases sufficient information was gathered
to make a final determination. In the remaining four cases, Panels identified that
needed medical, substance abuse, or mental health assessments were not completed.
The Panels supported the findings in 12 cases and did not agree with unsubstantiated
findings in six cases reviewed.

Recommendations
The following recommendations to enhance Arizona’s efforts to protect children are
made with the understanding that adequate funding, staffing and community resources
are essential for success.
•

Panels reviewed three cases that resulted in appeal hearings of substantiated
findings by Child Protective Services. In addition to the record reviews, training
was provided to the Panels on the appeal process. The Citizen Review Panel
concluded that Administrative Hearing Officers were not consistently trained on
critical issues, such as child maltreatment and child development. DCYF has
made available and encouraged participation in such training.
The number of substantiated reports declined since the appeal process began in
1998. Substantiated reports dropped from 20% for the period of April 2000 through
September 2000, to 12% for the period of October 2000 through March 2001
(Note: the number of substantiated reports for the most recent period does not
include cases that are pending the appeal process). There are a number of
possible factors that may contribute to a decrease in substantiated findings,
including the rate in which “proposed substantiated” findings are overturned.
During the period of November 2000 through October 2001, 53% of proposed
substantiated findings were amended through the internal review program, the
Protective Service Review Team. Substantiated findings were amended by the
Office of Administrative Hearings in 14% of cases elevated for hearing. The Panel
is concerned that, since the appeal process was initiated, case managers may be
reluctant to propose substantiation of allegations. Other factors that may contribute
to the decline in substantiated findings include: the decision to no longer
substantiate allegations of potential abuse or neglect; the lack of supporting
documentation in case records; and more consistent, stringent application of the
definitions of child abuse and neglect.
The Panel recognizes that the appeal process provides an essential opportunity for
due process, which might otherwise not exist. The reviews completed by the
appeal process, provide valuable information on the quality of investigations
performed by the agency and assist in identification of training needs.
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The Panel recommends that all hearing officers responsible for appeals of Child
Protective Services findings receive mandatory training on child maltreatment and
child development, as available through DCYF.

The Panel recommends that DCYF explore the impact of appeals on the rate of
substantiated findings and that a process for review of unsubstantiated findings be
established.
•

Reports not investigated, due to the inability to locate the family, are determined to
be unsubstantiated. Classification of a report as unsubstantiated should occur
after an investigation has been completed and the determination has been made
that sufficient grounds do not exist to substantiate findings.
It is the Panel’s recommendation that reports not investigated, due to the inability to
locate the family, be classified as “unable to locate”.

•

According to the Child Welfare Reporting Requirements Semi-Annual Report,
during the reporting period of 10/1/00 – 3/31/01, 548 substantiated reports were
closed after completion of the investigation. While the risks to the child may be
resolved for many of these cases during investigation, cases are closed in which
there is continued risk to the child. Typically, in these situations, the level of risk
does not warrant removal from the family home.
The Panel recommends consideration of in-home dependency petitions in cases
involving continued risk to the child.
The Panel recommends further development of community alternatives to ongoing
involvement with Child Protective Services.

•

One case reviewed involved allegations that a convicted sexual offender resided
with a child. At the time this report was accepted for investigation, reports such as
this were assigned as a potential risk, if there were no specific allegations that the
child had been abused. Subsequent to the date of that report, allegations have
been assigned as low risk if a child is living with a parent, guardian, or custodian
who has sexual abused a child in the past. Assignments of risk levels, high,
moderate, low, or potential determine the time frame for initiation of the
investigation.
The Panel recommends that allegations a child is living with a convicted sexual
offender, if the offense was against a child, should be classified as a moderate risk.

•

Investigations that involved families with multiple, prior reports of maltreatment did
not consistently evaluate the cumulative risk to the child. It is critical to consider
prior history known to the agency to identify patterns of risk factors. If there are
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Arizona’s Citizen Review Panel
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multiple reports on a family, agency policy currently directs staff to review all prior
reports and requires additional action such as reviews by management and
assignment to a different case manager for investigation.
The Panel recommends that policy on families with multiple reports be fully
implemented, through internal reviews and training.
•

The State Panel received an update on changes to the Comprehensive Medical
and Dental Program (CMDP) for Arizona’s foster care children. The Panel feels
that many of these changes will be very beneficial to the children covered by the
program. These children are at very high risk for a multitude of medical problems.
In addition, many of them have not received consistent medical care from a primary
care physician prior to ADES involvement. Thus, they often have untreated
medical problems, immunization delays, undiagnosed developmental delays,
hearing and visual deficits. Because these children are at high risk for such
medical problems, the committee would like to express their concern over the lack
of pediatric oversight of the CMDP program.
The Panel recommends that a board-certified pediatrician with experience in
primary care should provide consultation to the medical component of the CMDP
program. This physician could assist ADES in the development of appropriate
protocols, chart reviews, and development of tracking mechanisms to assure that
these vulnerable children receive the same quality of care available to other
children in the community.

•

One case reviewed included the fatality of a child in a family with active
involvement with Child Protective Services. In this fatality, the Medical Examiner
determined the cause of death to be the result of Sudden Infant Death Syndrome
(SIDS). The Panel noted that the established SIDS Autopsy Protocols were not
followed, and therefore other causes of death were not ruled out. It was felt that
thorough compliance with this protocol is critical for an accurate designation of
cause of death. Such a determination is essential to Child Protective Services in
their assessment of risk to surviving siblings.
It is recommended that the Sudden Infant Death Syndrome Autopsy Protocol
developed by the SIDS Council be utilized in every unexplained infant death.

Objectives for 2002
Arizona’s Citizen Review Panels have identified the following objectives for the next
reporting period:
•

Continue record reviews of fatalities and near fatalities of children due to
maltreatment, and other reports of serious maltreatment to identify systemic
problems and recommendations for improvement;

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•

Continue to collect and analyze data on all case record reviews;

•

Begin assessment of later stages of Child Protective Services involvement with
families, which include Case Plan Implementation and Closure.

•

Review health care provided to children in out of home care through Arizona’s
Comprehensive Medical and Dental Program (CMDP).

•

Provide support to DCYF, through consultation on policy, procedural changes and
state initiatives to improve the quality of services to children and their families.

Conclusions
Protecting children is the responsibility of the entire community and Child Protective
Services cannot be expected to successfully serve this mission in isolation. Volunteers
with the Citizen Review Panel are exemplary models of the commitment within our
community to the welfare of children and families. Findings and recommendations
included in this report are the result of dedication and hard work by the members of
each Panel.
It is important to acknowledge the efforts by DCYF to improve their efforts to protect
children. DCYF has engaged in several initiatives to enhance the well being of children
and families they serve. A few of these initiatives include:
•

The development of the Child Welfare Training Academy for Child Protective
Services.

•

Arizona Families F.I.R.S.T. (Families in Recovery Succeeding Together), in
partnership with the Department of Health Services provides substance abuse and
recovery support services to families involved with Child Protective Services and
Temporary Assistance for Needy Families (TANF). This program was implemented
statewide in March 2001.

•

The Family Builders program was expanded statewide during 2001. This program
provides family assessments and services to families in which there was a report of
low or potential risk to the child. With the aid of this program, there is now a
response to 100% of reports to Child Protective Services.

•

Family Group Decision Making expanded statewide in 2001. This program is
designed to empower families and their communities to protect and nurture
children, through their knowledge, support, and direction.

The Citizen Review Program desires to support DCYF in their continuing efforts to
improve services to children and their families. Success in these efforts is dependent
upon adequate funding and continued support from the community.
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Arizona State Citizen Review Panel Members
Chair:
Mary Ellen Rimsza, M.D.
Arizona State University
Members:
Lisa Barrientos, Detective
Mesa Police Department

Beth Rosenberg
Children’s Action Alliance

Angela Cause (former member)
AZ Baptist Children’s Services

Carolyn Rice
ADES/Administration for Children, Youth
& Families

Emilio Gonzales
ADES/Administration for Children, Youth
& Families

Rebecca Ruffner
Director
Prevent Child Abuse, Inc.

Dyanne Greer, J.D.
Maricopa County Attorney’s Office

Ivy Sandifer, M.D.
Physician

Tom Jacobson
Arizona State University
Student Health

Chuck Teegarden
Pinal County Attorney’s Office

Karin Kline
ADES/Administration for Children, Youth
& Families

Princess Lucas-Wilson
ADES/Division of Developmental
Disabilities

William N. Marshall Jr., M.D.
University of Arizona College of Medicine
Department of Pediatrics

Staff:
Susan Newberry
Program Manager
Citizen Review Panel Program

Dorothy J. Meyer
Indian Health Services
Virginia Richter
Attorney General’s Office

Robert Schackner
Director
Child Fatality Review Program

Evelyn Roanhorse
Bureau of Indian Affairs

Gwen Marshall, Admin. Assistant
Child Fatality Review Program
DeAnna Foard, Admin. Secretary
Child Fatality Review Program

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Pima County Citizen Review Panel Members
Chair:
William N. Marshall, Jr., M.D.
University of Arizona
College of Medicine, Department of Pediatrics

Coordinator:
Lori Roehrich
Zoe Ann Roe (former)
Members:
Christopher Corman
Foster Care Review Board
Az Supreme Court

Joan Mendelson
Attorney
Michael O’Connor
Pima County Sheriff Office

Anne Froedge
Attorney General’s Office

Cindy Porterfield, M.D.
County Medical Examiner

Lori Goenwald, M.S.W.
Tucson Medical Center
Denise Grenier, M.S.W
Indian Health Services

Carol Punske, M.S.W.
ADES/Administration for Children, Youth
& Families

Karen Ives
Wee Care Baby Proofing

Patricia Sheps
Providence Corp Sells Project

Sharon Katz
Pascua Yaqui Social Services

Cathy Stewart, J.D.
Attorney General’s Office

Chris Latas, M.A., R.N.
Kino Community Hospital

Bea Tashquinth
Tohono O’odham Nation

Marilyn Malone
Retired Detective, Tucson Police
Department
Rebecca Manoleas
CASA, Pima County Juvenile Court
Kathleen Mayer
Pima County Attorney’s Office

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Yavapai County Citizen Review Panel
Chair:
Rebecca Ruffner
Prevent Child Abuse, Inc.

Members:
Ryan Bond
Assistant Program Manager
ADES/Administration for Children, Youth & Families
Joan Crosby
Project Director
Prevent Child Abuse, Inc.
Charles Hastings
County Attorney
Yavapai County Attorney
Ron Hawley
Supervisor
Child Protective Services
Mary Ellen Heintzelman, RN, MSN, CPNP
YRMC/Partners for Healthy Students
Wendy Johnson
Detective
Verde Valley Sheriff’s Office
Barbara Polk
CASA & Yavapai County Community Foundation
Rebecca Ruffner
Prevent Child Abuse, Inc.
Victoria Witt
Yavapai County Attorney’s Office

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