In the OCA 2023 Annual Report, we made the following recommendations to MDHHS. 

• Marquette County DHHS adhere to MCL722.628d in determining when to file a petition. 
• That child welfare partners In Marquette County set a standing monthly or bl-monthly meeting.
• That DHHS develop a new process to ensure case specialists are adequately investigating and addressing new allegations that come in during an open investigation or open services case. 
• Remove the policy provision that allows the CPS caseworker to provide information to a professional at the medical facility when the medical practitioner is not available. 
• Amended policy to require that case conferences between CPS caseworkers and their supervisors be documented in narrative format in the case's social work contacts. 
• Require local county directors to develop processes in coordination with the local Multi-Disciplinary Team (MDT) to include detailed direction on how to request and access a second medical opinion, to develop county-specific protocols on obtaining a second medical opinion, and to train CPS workers and Supervisors on those specific protocols as well as the impact of obtaining the second medical opinion in a timely manner. 
• Child welfare investigations require law enforcement and CPS caseworkers be proficient in detecting abuse and neglect. 
• Amended policy to mandate the annual in-service training include objectives on the detection of injuries attributable to child abuse. 
• DHHS assist families when a safety plan removes the support system currently in place. 
• DHHS require local county directors to collaborate with their MDT to develop a working list of medical practitioners who have specialized training in detecting child abuse and neglect, examining, and interviewing children, mandate and update the list of statewide and local child abuse medical experts with caseworkers and supervisors, train CPS caseworkers and supervisors on the critical importance of using the child abuse medical expert list when scheduling initial and second opinion medical examinations, and invite medical practitioners from the child abuse and neglect list to MDT meetings and case reviews. 
• Anyone Identified as a person with firsthand knowledge of the allegations when the complaint is called into Centralized Intake.
• MDHHS require local county directors develop process in coordination with the local MDT.
• Adjust policy and Michigan Model Child Abuse Protocol to require in person or phone contact with law enforcement when MDHHS Is required to submit a LEN. 
• Implement units within the Children's Services Administration that specialize in the handling of foster care cases Involving vulnerable children.
• MDHHS amend policy requiring caseworkers to make collateral contact with mental health professionals when there Is evidence of psychosis in a parent during a CPS Investigation, and that the CPS policy manual define psychosis.
• Amend policy pertaining to the threatened harm assessment. 
• Amend policy to add a question to the safety assessment specifically surrounding parental mental health similar to those found in New York and Ohio CPS safety assessments. 
• MDHHS amend policy to require the assigned case manager conduct interviews with treating medical professional(s) as part of an investigation into physical abuse, sexual abuse, and/or severe physical injury. 

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In the OCA 2022 Annual Report, we made the following recommendations to MDHHS. 

• The MDHHS Children’s Services Administration develop and implement a new training to be offered to all CPS staff and mental health workers statewide. This training should help ensure compliance with MCL 330.1748a, MCL 333.2640, and MCL 333.16281 regarding the sharing of clients’ mental health records during an investigation of suspected child abuse or neglect, even without the client’s consent. This training should focus on when these laws and policies are applicable, how to utilize and comply with their requirements, and what to do if CPS experiences resistance from mental health care providers.
• The MDHHS incorporate into their training of new and ongoing child welfare staff a portion dedicated to mental health and illness of clients. This aspect of training should focus on understanding the types, causes, and symptoms of mental illness, what treatment modalities are available to care for such individuals, and the impact a caregiver’s mental illness can have on the child(ren) in their care. In doing so, an emphasis should be placed on the assessment and response to a client’s propensity to harm or neglect themselves or others, particularly the child(ren) the client is caring for. This training should occur for all new child welfare staff and be repeated on a regular basis, so workers are adequately prepared to assess and react to such situations should they arise in a case.
• The MDHHS Children’s Services Administration consider amending the Children Protective Services Manual, PSM 713-08, Special Investigative Situations, to include a section that addresses how CPS should respond when a caregiver’s mental health condition is potentially placing a child in harm’s way. The Children’s Ombudsman recommends this section could include the following items:
  • An expedited timeframe for when to make collateral contacts, such as with mental health providers. Instead of a discretionary timeframe for making collateral contacts as in PSM 713-01, this section could prescribe that such contacts be made within 24 to 48 hours of receipt of the complaint when the complaint alleges potential harm to a child due to a caregiver’s mental health issues.
  • Allow for extensions of the 30-calendar day standard of promptness to obtain and review mental health records of the client.
  • Provide an assessment tool or other way to assess a caregiver’s ability to continue to meet the needs of the child(ren) in their care. This could include questions like those in PSM 716-7, Decision Making for Cases Involving Substances, and include, but not be limited to, the following:
    
    • Is there evidence to demonstrate difficulty regulating emotions or controlling anger?
    • Does the caregiver’s mental health condition reduce their capacity to respond to the child(ren)’s cues and needs?
    • Are there supports such as family and friends who can care for the child(ren) when the parents are not able to?
    • Are the parents willing to use their supports when necessary?
    • Is the caregiver taking their medications as prescribed? If not, does this present a possible harmful situation for the caregiver or others?
    • Has the caregiver’s mental health condition caused substantial impairment of judgment or irrationality to the extent that the child(ren) was abused or neglected?
  • A requirement to obtain and review all records from each mental health provider of the caregiver.
  • Access to databases, such as the Judicial Data Warehouse (JDW), where CPS can check for any involuntary hospitalizations or commitments.
  • An automatic referral to preventative services whether a preponderance of evidence is found or not.

• The OCO recommends that partners (Children’s Protective Services, law enforcement, and the courts in Mason and Manistee counties) come together to review this case and discuss it in the context of guiding law, policies, and protocols. The OCO also recommends that MDHHS Children’s Services Agency review this case and consider providing guidance to all county offices on their legal responsibilities after a law enforcement officer has removed a child from parental custody.
• MDHHS Children’s Services Agency amend FOM 722-03B to emphasize that adherence to deadlines and documentation requirements are crucial to fully implementing the preference for relative foster care placement in effect during the 90 days following removal of a child from parental custody.
• The OCO recommends that MDHHS Children's Services Agency develop an internal review, oversight, or quality assurance mechanism regarding contracted entities’ compliance with law and policy on relative placement processes. Timely adherence to law and policy regarding relative placement is in the best interest of the child, and to that end, achieving greater compliance is necessary. Furthermore, the OCO strongly recommends that MDHHS finds meaningful ways, including provisional licensing, to hold these contracted agencies accountable when relatives are routinely disregarded when seeking placement of children.

In the 2021 OCA Annual Report, we made the following recommendations to MDHHS. 

In the OCA 2020 Annual Report, we made the following recommendations to MDHHS. 

• The OCO recommends that MDHHS require a heightened response by DCWL to statutory or 
  administrative rule violations regarding restraint, staff physical abuse of a resident, or failure to 
  comply with the mandated reporting provisions of the Child Protection Law (CPL) by a CCI. This heightened response could include the following:
  
  • For a second or subsequent violation of law or administrative rule concerning restraint, staff physical abuse of a resident, or failure to report, issuing a provisional license to the CCI; and
  • For any violation of law or administrative rule concerning restraint, physical abuse of a resident, or failure to report, requiring DCWL to notify local DHHS offices of its findings to permit local offices to decide whether to seek re-placement of children under their care and supervision.

• The OCO recommends that MDHHS identify jobs within the state civil service that are substantially similar to the position of direct care worker at a private non-secure CCI. MDHHS should require by contract that pay rates for direct care workers within private non-secure CCI's be commensurate with the department's pay rates for substantially similar positions within the state civil service and include pay differentials for employees with relevant child welfare experience.
• The OCO recommends that MDHHS add a requirement to Michigan Administrative Rule 400.4128; Rule 128, to require all direct care workers in CCI's, similar to the first aid training requirement, to take Parent Resources for Information, Development, and Education (PRIDE) training as required for foster parents.

• The OCO recommends that the Michigan Legislature amend the Child Care Organizations Act, MCL 722.111 et seq., to limit the number of children that a CCI may house within a self-contained unit of a facility to 19 residents or less. 
• The OCO recommends that the Michigan Legislature appropriate sufficient funds to support the establishment, monitoring, and administrative costs of CCI’s with smaller resident populations as recommended in this document.

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In the OCA 2019 Annual Report, we made the following recommendations to MDHHS. 

• The OCO recommends that the Michigan Department of Health and Human Services (MDHHS) implement a unit within the Children’s Services Agency that specializes in the handling of cases involving vulnerable children. These children are at a higher risk for abuse and neglect. 

• The OCO recommends that caseworkers assigned to vulnerable children’s cases have a pre-determined minimum amount of case management experience, additional specialized medical training and a reduced caseload. This will allow a case manager to more accurately service a vulnerable child, document and ensure all their needs are being met, make the required contacts with medical professionals, identify and address all needs of the child and caregiver, document and accurately report all concerns of a child’s placement to the court, and take action upon receipt of information that their safety and well-being is at substantial risk of harm in their current placement and a placement change is warranted. 
• The ombudsman recommends that bringing attention to this important aspect of an investigation can be accomplished by highlighting interviews of reporting sources and collateral contacts in the training atmosphere. Both in the training of new CPS staff and in conducting in-service trainings, the value of interviewing witnesses should be stressed and taught as the fabric of any investigation. Interviewing reporting sources and collateral contacts should become the norm and part of the culture of a CPS investigation. The investigator must also be taught and provided examples in training of the important questions to ask. It is recommended that in developing training, the MDHHS develops real-world curriculum to discuss what questions an investigator can use. It is also recommended that the department employs scenario-based training, using veteran investigators as actors. To be effective, the scenario-based training should be conducted in smaller groups, and the teams of veteran investigators can be used after the scenarios to debrief the employees being trained. The debriefing of the scenarios should go over what the trainee did that was not successful, but also what the trainee did that was successful. The use of scenario-based training, coupled with debriefing of the scenarios, will help cement the importance of conducting these interviews during investigations.

View the full report here