MDT Leadership Team
Meeting Minutes
February 11, 2016
12:00 – 3:00 PM
ChicagoCAC Education Center
Members Present: Ana Correa, Char Rivette, Sgt. Cindy Guerra, Dr. Emily Siffermann, Jacqui Colyer, Jan Waters, Dr. Jill Glick, Joan Pernecke,. Kristen Bilka, Dr. Marjorie Fujara, Lt. Patricia Casey, Sgt. Patricia Stribling, Ruby Powell, Shawnte Jenkins, and Commander Tom Lemmer
Members Absent: Annette Milleville, Carla Jackson, Denyce Ellis, Elizabeth Mendoza, George Canellis, Sgt. Hector Vergara, Sgt. Jeffrey Coleman, Jennifer Gonzalez, Deputy Chief Kathleen Boehmer, Kevin Lameka, Margaret Ogarek, Sgt. Nari Haro, Dr. Sandeep Narang, Sgt. Senora Ben, Tammy Bates
1. Welcome/Introductions/Announcements
2. Approval of January Meeting Minutes—Minutes were approved with no changes.
In lieu of Dropbox, we have set up a page on the website with old meeting minutes, the MOU, the protocol and the operational agreement. We will add quarterly performance reports as well as MPEEC information. A reminder that this is for meeting materials only: nothing case-specific. Michelle will send everyone the link.
3. New Intake Coordination System: Transition Phase and Logistics
§ Char offered some background on this change. As most know, the time between case receipt and FI has been getting progressively longer. We are up to and often beyond 14 days. All agencies agree that this is unacceptable. A Think Group meeting was held last month, and the leadership team determined that the agency needs to take a “family first” approach. Basically, we will handle all cases similarly to the way we’ve handled emergency cases in the past. Once Intake receives a case, they will reach out to the family within 24 hours and try to get them here for an FI (and medical whenever appropriate/possible) within 48 hours. We will “go live” with this new plan on March 1, and learn as we go. We may learn that we need more staff during after-school hours and fewer during the school day, for example, and will adapt to what we learn as we are able. Everyone should be offering feedback as we progress. To assist with the transition, Elizabeth Mendoza will be holding weekly meetings with each agency to trouble-shoot problems. We ask all leadership to help with this process as much as possible. Some investigators are already going to Arllette and asking her to make exceptions for their cases. We need to be clear from the top down that this isn’t going to happen, as too many exceptions will negate the entire practice. Arllette should not be in the middle of this: any questions or concerns need to be dealt with during the transition meetings with Elizabeth.
§ Dr. Fujara shared the plan the clinic has developed for March. In the past, the clinic’s hours have been 9am-5pm, with the last patient slot at 3pm. Beginning March 1, patient slots will be added at 4, 5, 6, and 7pm. Dr. Siffermann will work normal business hours and Dr. Fujara will start her day later and remain in the clinic until 9pm. Since union law doesn’t allow for extending the nurse or nurse assistant hours, Dr. Fujara will also learn how to register patients, order labs, etc. Advocates and Child Life staff will act as chaperones in the exam rooms when needed. Children requiring evidence kits will be sent to the hospital. As time goes on and we determine our needs, we’ll consider whether it makes sense to make certain days of the week the “late days” instead of having extended hours every day.
§ Jacqui Colyer asked whether we have determined an ultimate goal of this new system. Is there a certain percentage of children we are trying to see within 48 hours? Char noted that in our last round of data, the percentage of children not seen for FIs within 48 hours due to team schedules was a very high 47%. During the first half of FY16, only 20% of cases came in for an FI within 48 hours. Success will be seeing those numbers change drastically. It seems premature to try to set a specific goal right now. Seeing what happens in March will give us the information needed to determine a realistic goal.
§ Commander Lemmer asked that as we begin the new system, we track how often the detectives observing the FIs are not the assigned case detective. We will do that for both CPD and DCFS. Dr. Fujara noted that we should track the number of medicals occurring on the same day as the FI. Char noted that we also want to see how this new system impacts the number of cases referred to mental health services at the Family Hope Center or with PATHH providers. There was also a suggestion that we attempt to track disclosure rates to see if there is a change in rate when the time between case receipt and FI is shortened.
§ Shawnte noted that we still have 18 pages worth of old cases we are trying to clean up to avoid bringing them into March. A list of these cases will be going out to all partners on Monday asking for decisions.
§ Shawnte shared that we will be sending data out weekly as we move into the new system so everyone can clearly see how many cases are coming in within 48 hours with this approach as opposed to the old way. Once we have a few weeks of data to work with there will be a large visual added to the wall by Intake.
§ Jacqui noted that we should give ourselves as a leadership team a lot of credit for moving forward with this change despite the pushback.
4. Convening of Medical Providers
With Dr. Fujara taking over the medical clinic here at Chicago CAC, she and Char decided it was a good time to have a convening of medical providers from the hospitals with qualified child abuse pediatricians who are most likely to see children for alleged sexual abuse. While the clinic itself is a great resource, not all kids end up here. The goal is to have as many alleged victims as possible come here and, when that’s not possible, make sure they are sent to hospitals such as Comer and Lurie where we know they will be seen by someone with the appropriate expertise, at a place that will provide family- and child-sensitive care. As very few children need an emergency physical exam, the emergency room is almost never the right place for these kids. Dr. Fujara wants to lead a discussion with fellow expert medical providers on how they can work together to ensure that children are getting care in the most appropriate setting, and how to make sure the investigative team at ChicagoCAC has the information they need to move forward. We haven’t heard back from everyone yet, but once we do Michelle will send out a doodle poll and get something scheduled.
5. Data Review
§ The Quarterly Performance Report distributed today (data through the first half of the fiscal year, July 1-December 31, 2015) was just completed this morning, so we know everyone hasn’t had a chance to look at it. Perhaps we will discuss it in more detail at the next meeting. At a quick glance, the number of reports is up a bit compared to this time last year.
§ There was a request to provide data on where kids are seen for medical exams if not at the clinic. Knowing exactly which hospital would be ideal. We would also like to see data on how many cases the clinic is reviewing.
6. Format of New Combined Meeting
There was some discussion as to whether we should start at noon or 12:30. We also discussed whether the second half of the meeting will always start at 1:30. It’s hard to know the answer to that yet. The decision was to stay the course for a few months and see how things go, and then adjust if necessary.
7. MPEEC Dashboard, Goals, and Problem Solving
§ The Dashboard will be added to the MDT web page. Its purpose is to be used as a roadmap for facilitating conversations, to help us streamline and focus.
§ The group discussed whether it’s appropriate for the MPEEC coordinator to attend this meeting in its new format. Some feel that as she’s the key person facilitating communication, she needs to be here. Others feel that we need to have the people who can actually make decisions at this table. We’re trying to raise the level of what we’re discussing in this meeting. While no one wants to minimize the importance of the coordinator’s role, she is not a part of determining the program goals, and the idea is for these meetings to be more of a systems approach. Kristen Bilka noted that historically, the main presence of MPEEC at ChicagoCAC has always been the coordinator, so while no one is disagreeing with the fundamentals of who is present, there is concern because it’s a noted difference. Shawnte stressed that she and Elizabeth are overseeing MPEEC more now, and therefore the coordinator’s position and responsibilities have changed.
§ Dr. Glick expressed that this is the time to “blow MPEEC up and start over.” It’s time to take a close look at the best way to make the program start functioning better, as she doesn’t feel we can move forward in the same way we’ve been going. It’s crucial to have consistent CPD and DCFS presence. When MPEEC first started, there were regular, every other day phone calls between agencies. They are not happening. People are not calling back. We need a unit-based MDT of people
“in the trenches” who want to do this work and are invested in it.
§ Sgt. Stribling invited Dr. Glick to come out to her area to talk about serious harms cases. While Dr. Glick is willing to do so, Commander Lemmer noted that she can’t keep coming out and starting over. There needs to be a clear protocol that is understood so we aren’t starting from scratch every time someone new begins. Char noted that this is one of the major reasons we want a protocol and/or MOU for MPEEC the same way we have one for CSA. Collaboration is needed above all.
§ The group discussed Sgt. Guerra’s role as liaison. If the MPEEC coordinator has difficulty getting in touch with the appropriate detective, Sgt. Guerra will reach out. She is able to call area reps on their cell phones and obtain information that a civilian might be unable to access, and then pass the necessary information on.
§ Commander Lemmer stressed that we need to embrace a three-tiered approach in serious harms cases:
--Step 1: the doctor should reach out directly to the area rep to jump-start the flow of information. To facilitate this, the name of the sergeant and the RD number should be added to the MPEEC contact sheets. If sergeants are looped in early, perhaps it won’t feel punitive. It will be the new normal and help foster relationships. Sergeants also need to make sure their detectives understand the importance of keeping in touch with the doctors. If this becomes automatic and embedded in the culture, maybe eventually there won’t need to be an MPEEC coordinator at all!
--Step 2: Sgt. Guerra should be kept appraised of day-to-day developments
--Step 3: Commander Lemmer will bring this issue to the Chief to try to create a protocol. Everyone agrees that doing something like this in a piecemeal, ad hoc way never works.
§ The group discussed the MPEEC trainings that take place for DCFS three times per year. The Commander will work to have substantial police representation. Shawnte will let the commander know how many spots are available for CPD when she has that information. Char noted that the MPEEC doctors also did a special training for the SAO at one point, and could do another similar one for CPD if necessary. Char shared that we will also be rolling out a training for judges in the next six months, and Dr. Glick added that one of the Children’s Justice Task Force recommendations to the General Assembly is that all judges dealing with child welfare cases receive this training.
§ Dr. Glick will keep some preliminary data on who the detectives are for cases and how the communication flow goes. There was a brief discussion about trying to steer cases towards those detectives we know handle them exceptionally, but that tends to create a climate where some people are stretched too thin.
§ Char will begin working on the protocol, figuring out the ideal scenario for how these cases come together.
8. Second Opinion Cases
Dr. Glick brought up a case that she was assigned two months after the fact and was unable to review, as by then the child was a ward of the state. The group discussed the need to get information out to doctors as soon as possible when second opinion cases come up. Some doctors have said in the past that they don’t want to be called with just a synopsis; that they need the full information. The majority, however, seem to want the information as soon as possible. The MPEEC coordinator should proceed with that time table as the default.
9. Next Meeting: MDT Leadership Meeting – Thursday, March 10, 12-3pm
Future Discussions: