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At DHS, all eyes are on change

New nurses. Quick response to the youngest clients. Phila. child-welfare officials say they are shaping up.

Arthur C. Evans offers the following story as evidence of how far the city agency responsible for abused and neglected children has come in just a few months.

A social worker had little reason to suspect anything was amiss with one of her charges. Bandages on the child's bedsores were clean. She didn't complain of pain. But recent changes had led the troubled agency to hire two nurses for the first time.

So the social worker asked one to come along on a home visit. The nurse peeled away a white bandage and peered at a bedsore. The wound was deep.

"She said this child needs to see a doctor now," said Evans, the acting commissioner of human services. "She saved a life."

The hiring of four nurses - two are in place, two more are coming soon - is just one part of what Evans described as a sweeping overhaul undertaken by the Department of Human Services since an Inquirer investigation last fall raised questions about the deaths of 25 children in its care over three years.

What will eventually emerge, he said, is a tighter, more efficient agency that does a better job deciding who it can help and how it can keep children safe.

Workers, he said, will respond immediately to the youngest, most vulnerable children. Field workers, for the first time, will get a practice guide to help them interpret what they see and hear in a home. More powerful computer hardware and software will help manage cases.

"We have not been sitting on our hands," Evans said in an interview Tuesday, as workers began training on a new safety assessment form that helps them decide whether a child is in danger.

The training marks the beginning of the second phase of the agency's reform plan: two dozen initiatives ranging from developing an e-mail system to alert DHS when an independent field worker learns that the parent of an abused child is pregnant again, to computers that keep on top of court orders.

Meanwhile, the state is beefing up its own oversight in Southeastern Pennsylvania, adding eight staff members and stiffening the licensing process for contractors.

"We're really working hard to support DHS and keep children safe," said Roberta Trombetta, regional director for the state Department of Public Welfare.

A self-assessment by the city agency found many of the same problems detailed in Inquirer articles, including shortcomings in how the agency investigates neglect and abuse complaints, oversees contractors and handles parents and children with disabilities.

One case highlighted by the paper was that of Danieal Kelly, a 14-year-old girl bedridden with cerebral palsy who died in August from heat exhaustion in her Mantua home. Paramedics found maggots in her bedsores.

Upon learning of the case, Mayor Street forced out Commissioner Cheryl Ransom-Garner and her deputy, John McGee. That same day, Street said he would appoint a panel to overhaul the agency and placed Evans, the director of the city's Department of Behavioral Health and Mental Retardation Services, in charge of DHS.

Although the outside panel is looking at how to restructure the agency, Evans is moving ahead on changes now - with the panel's blessing, he said.

Most of his reforms are based on two sets of findings: 36 recommendations, largely ignored, that internal child-fatality review teams had made over the last six years, and home visits in the last six months to all 6,728 children who fell under child protective services.

On each home visit, workers gathered information from clients about how well independent contractors were protecting children and how agency staff performed in each case.

As a result, DHS has begun legal proceedings to remove 142 children from 80 families. And it is moving to close the cases of 283 families whose homes are believed to be safe.

Along the way, Evans said, the agency discovered new needs - including having nurses available to identify health issues such as the ones that killed Danieal Kelly.

The two new nurses may already have saved two lives, he said. Besides the bedsore case, a nurse spotted an infant who was not getting a daily dose of anti-rejection medication for an organ transplant, placing the child in severe danger.

In the agency's review, "one thing that became apparent was that many children had serious medical issues," Evans said. Nearly 1,200 children had physical health problems, 332 had developmental issues, and 1,052 had behavioral health issues.

Given the numbers, some say the new hires may not be enough.

"It's an excellent idea, but four nurses for this number of children is too few," said Dan Taylor, a pediatrician at St. Christopher's Hospital for Children, where many abused children are taken.

"Unfortunately, DHS is one of the only eyes we have into these kids' homes," said Taylor, adding that some infants and children he treats may go years between appointments.

The agency recognizes that problem, Evans said, and will not depend only on nurses. DHS will require workers who see children to conduct safety inspections during each home visit and promptly report when a child misses doctor's appointments.

He also wants to respond more quickly to children who are younger than 2.

"These are the children who are most at risk and where we have the most deaths."

Evans said he wants workers - contractors - to see children under 2 years old at least weekly. "We will put eyes on kids," he said.

Communication between contractors in the field and DHS caseworkers in the office is critical because DHS staffers do not normally provide direct services. They oversee the contractors who do.

Evans said the agency is scrutinizing contractors more carefully. It has ended new cases for four contractors who provide services to children in their own homes, terminated one foster-care contract, and stopped sending new cases to another.

In the Kelly death last summer, DHS had hired a service provider who it now says was falsifying paperwork to indicate home visits that were never made. To prevent this in the future, DHS is hiring five additional staff to oversee contractors.

"We need to work better with providers to make sure they are doing a better job," said Evans.

He said the agency needs to develop the capability to conduct yearly evaluations of contractors and perform random audits. Currently, reviews are done once every two years.

Evans said DHS is upgrading training and computer systems, continuing changes started under previous commissioners.

One system, for example, will allow supervisors to oversee and track every decision a caseworker makes.

So what will it all cost? Evans said that it's too early to tell, but that the agency has most of the money it needs, and that the state has committed to help. One key question is how both the city and state will make sure the changes continue under the next mayor.

"My intention is to get so much momentum behind these reforms that they will keep moving forward," Evans said.

Read continuing coverage of the city child-welfare agency at