MDT Leadership Team
Meeting Minutes
May 12, 2016
12:00 – 3:00 PM
ChicagoCAC Education Center
Members Present: Ana Correa, Annette Milleville, Char Rivette, Denyce Ellis, Dr. Emily Siffermann, James Murphy, Jan Waters, Dr. Jill Glick, Joan Pernecke, Kristen Bilka, Margaret Ogarek, Dr. Marjorie Fujara, Sgt. Patricia Stribling, Ruby Powell, Dr. Sandeep Narang, Shawnte Jenkins, Tammy Bates and Commander Tom Lemmer
Members Absent: Carla Jackson, Sgt. Cindy Guerra, Elizabeth Mendoza, George Canellis, Sgt. Hector Vergara, Jacqui Colyer, Sgt. Jeffrey Coleman, Jennifer Gonzalez, Deputy Chief Kathleen Boehmer, Sgt. Kevin Lameka, Sgt. Nari Haro, Lt. Patricia Casey, Sgt. Senora Ben
Guest: Arllette Antunez
1. Welcome/Introductions/Announcements
We welcomed new member James Murphy, Felony Review Deputy Supervisor. He is replacing George Canellis, who is now a judge and no longer eligible to be part of the team. Char noted that we are still in the experimental phase of this combined MDT/MPEEC meeting and still figuring out the best way to make it work.
2. Approval of March Meeting Minutes—Minutes were approved with one change: Intake shouldn’t call ASAs directly because ASAs change so frequently. Instead, Intake should contact the Child Advocacy Protection Unit either in their office, on the phone, or through Felony Review.
3. Staff Advisory Council Update (Arllette)
Arllette noted that the SAC’s last meeting focused on the Family First process. She is aware that the Think Group met recently and has discussed some of the same things, but there are two issues to address:
§ As Leadership, please remind staff that the transition to Family First was made by Leadership as a group, not by the Intake department. Intake is getting badmouthed inappropriately and unprofessionally for the change.
§ When partners cancel FIs coordinated by Intake, Intake requests that the partners then handle the rescheduling. Intake will assist by providing information but should not handle the reschedule. Intake is often not finding out about these reschedules until the day they were originally scheduled for. While the hope is that partners will not “cut side-deals” either with one another or with the families, when that does happen, they need to make sure that the other partners are aware as well as circle back to let Intake know.
4. Family First Approach: Transition and Progress/Think Group Update
§ One of the biggest takeaways from the Think Group meeting last month was the fact that March was an exceptional month, with 255 new reports coming in. That number, and the scheduling issues resulting from it, had nothing to do with the Family First process. No one is entirely sure of the reason for the increase, but it seems to have been county-wide. Dr. Fujara noted there was a tremendous influx at the hospital in March as well.
§ When the old cases still being cleaned off the roster were removed from the data, the average case coming in after March 1 received an FI within 5 days.
§ The disclosure rate was slightly up for Family First cases.
§ Commander Lemmer noted a concern with increased difficulty in squeezing in “stranger danger”/emergency cases. Shawnte noted that those should be accommodated the same way they have been in the past. She wonders if this was an issue due to the unusual business in March. She will speak to Arllette and check back in. Commander Lemmer noted that they are not asking for any kind of change right now, but simply raising the concern. Peg asked, if ChicagoCAC is unable to see an emergency case, whether it is acceptable to contact another CAC. While that’s acceptable, it is not ideal.
§ Commander Lemmer shared that CPD is currently short due to some detectives attending Sergeant’s training. Because of this, they would like to avoid additional burnout as much as possible. In service of that, they would like to limit the number of FIs detectives attend in a day to two.
§ CPD would like to make sure that when FIs are scheduled for times when the assigned detective can’t attend, the assigned detective is informed of the reason and the families are also informed that their assigned detective will not be in attendance.
§ There is a concern that when multiple siblings are scheduled for medicals in one day and the FI(s) take place after the kids have been here for hours, the quality of the FI might suffer. This is something to be aware of when scheduling.
§ DCFS noted that they have no update on the way Saturdays are scheduled. Ideally, Saturday workers assigned to ChicagoCAC should be available for FIs, but it simply doesn’t always work that way.
§ Peg commented that the SAO is still not getting scheduling notice consistently, and asked if there was anything they could do to help Intake get information to the SAO at a faster place. Peg also wants to make sure that any re-interviews are discussed before they are scheduled. She had to cancel one today due to a pending court case.
§ There was a recent issue where a perpetrator had been involved in a previous case and Intake was unaware. This is an issue with ETO that ChicagoCAC is aware of and working on. If any partners know there is a perpetrator on a case who has also been the perpetrator on a previous case, they should let Intake know.
§ Things have been working well overall in the Medical Clinic. They are currently unable to continue the extended hours they attempted in March, but they learned some important things from the attempt and would like to bring that option back in some form when they are better staffed.
5. Update on Convening of Medical Providers
§ The recent convening of Medical Providers included representatives from both Lurie and Comer. Dr. Fujara was able to share the process at the clinic here as well as the outreach that’s been done throughout the city. It was good for doctors to hear the whole process of what happens when a victim comes here. They also discussed some strategies to get medical records in faster. The issue of “interviews” taking place during medicals performed at other hospitals was cleared up, with representatives noting they would be sure to educate staff.
6. Review of 3rd Quarter Performance Report
§ Investigative referrals have increased by 13% over FY15 and the percentage of cases receiving FIs was also up slightly. The unusual number of cases in March certainly accounts for some of that percentage.
§ In the Days to FI chart, 35% remain at 15+ days. This includes all cases for FY16, however, including the backlog. If we looked at that data month to month, we would see the differences in that rate more clearly.
§ Demographics remain similar, as does the disclosure rate.
§ Trafficking is a new category in the Types of Referrals chart. The group determined that it might be helpful to have a DCFS worker attend the Human Trafficking Task Force meetings. Stacey Sloan is there, but she handles more administrative work: having a caseworker attend would be great. DCFS should decide on a representative and Shawnte will let them know when the next meeting is.
§ Jan Waters noted that the increase in the percentage of families not attending therapy sessions regularly is due to the increased number of therapists and, therefore, families involved. With the increase in reports and FIs, the wait list is back up. They are working on moving families along if they are not using services well. A new ICM also began this month, and the hope is that will have a positive impact on engagement.
§ The number of Medical Exams was nearly identical YTD. There was a discussion of looking into capacity utilization for the clinic. Dr. Siffermann offered to take on that project.
7. Review of ChicagoCAC Operational Agreement
§ The new Cook County Protocol was distributed. Michelle will also email it out to everyone, in addition to the “blue ink” sections of the Operational Agreement that need to be reviewed. We will discuss this at the next meeting. The sections needing review are the CSEC screening process and the protocol for registered sex offenders in the building.
8. Review of 3rd Quarter Performance Report (MPEEC)
§ There was a discussion of the percentages on the Mandated MPEEC Injury Types chart: the data there is Intake data, not the data from the close of a case. If we looked at data when cases were closed, there would likely be many additional multiple traumatic injury cases.
§ There was a request to see data for on-site vs. off-site cases as well as mandated vs. second opinion.
§ We hope to be able to compare our data to hotline data. Recently, Ursula has not been receiving reports on the MPEEC fax that are coming into Comer. Ruby Powell offered to serve as a liaison if this continues. Nora Harms did double-check recently to be sure we were getting all the cases of children under three and we seem to be. Char noted that an MOU is in progress between DCFS and all CACs to allow for additional information to assist with quality assurance in this area.
§ The data point that 61% of MPEEC offenders are female might not be accurate. Reports seem to be made in the mother’s name the majority of the time regardless of perpetrator. It might be more useful to look at all offender demographic data (sex, race, age, etc.) with the “unknowns” removed, and just look at the breakdown when known.
§ There was a discussion about whether “negligent” was the correct term to be using on the Mandated Case Outcomes chart. There was some disagreement between partners about whether there is a difference between negligence and neglect. Everyone wants to be careful that doctors don’t appear to be trying to step into a legal role as opposed to a medical one. There was also some discussion about whether “indeterminate” is being used to mean “incomplete record” or “unable to (ever) determine” or some combination. The doctors would like to sit down together and hash out language to make sure they all agree on the terms and are using the same ones. Dr. Narang noted that it’s no wonder there’s no consensus among this group, as CAPs as a whole sub-specialty do not have a consensus. To start, we will go ahead and change “negligent” to “neglect.” We will commit to using the other established “buckets” until future conversation occurs, and will note in the FY17 MPEEC Program Plan that we’ll be examining terminology. The doctors will discuss language among themselves and then bring their thoughts back to the partners to make sure everyone is in agreement.
§ We are meeting our goal to reduce the number of days between referral to MPEEC and MPEEC disposition to an average of 30.
§ We are not quite meeting the goal to assign all mandated cases to an MPEEC physician within 48 hours. There was previously disagreement about assigning cases immediately vs. waiting for further information. We should be able to meet our goal now that we’re being more consistent in this area.
§ Joan noted that the value of MPEEC is being more and more widely recognized: appellate courts are starting to appreciate the importance of the work as well.
9. Encryption of Files/Delayed Delivery of Records
§ Dr. Narang brought the issue of sharing confidential medical information (medical records only; pictures of, for example, a child’s sleep space are not an issue) via unsecured email systems to Char’s attention. Char noted that everyone has different levels of “OKness” with information being shared via email. Meryl Paniak from DCFS legal connected Char with someone yesterday to assist us in using some sort of encrypted system. We are working to get this going and will try to make it as user-friendly as possible. Dr. Glick asked if the doctors might be able to look at whatever is proposed before it’s implemented. That shouldn’t be an issue. We also don’t know how individualized we might be able to make something like this.
§ The group discussed how frequently medical records come across email. Perhaps ChicagoCAC doesn’t need to be an intermediary in this, and records should just be passed from hospital to hospital? There had been previous discussion of legislation to allow a HIPPA exception for doctors to communicate with one another in the course of an investigation, but Joan is unsure whether it went through.
10. Possible Increase in Off-Sites (Dr. Dakil has left Advocate Christ)—simply an FYI.
11. Other Business
§ There was some discussion about waiving off-sites at Rush, but it was determined that the CAP credentials of those seeing patients there are still not consistent. The group agreed that if the doctors who are assigned cases think the opinion in the chart stands (if it’s from another board-certified CAP already on the case), there is no need for an off-site, but there is not enough consistency accross the board at this time to make that the policy for any particular hospital.
§ The group discussed the importance of continuing to develop the relationship with CPD. Everyone agrees that specialization within both CPD and DCFS is crucial. There needs to be a small, consistent unit. The vision is there, but we are not there yet.
§ Commander Lemmer noted that we need funds behind mandates. There are too many mandates that simply have no funding. We need Director Sheldon to be fighting for this along with us.