Children and Family Services: By The Numbers (December 2020)

FamilyChildren & December 2020 Services By The Family First Numbers New Focus - New Futures What the data says about Out-of-State Who we are, Placement What we’re doing, & Where we need to go. Keeping our children close Redesign How do we keep our children safe and our families strong A publication of

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An electronic version of this document can be obtained by visiting the following website: http://www.nd.gov/dhs/info/pubs/family.html MISSION STATEMENT To provide quality, efficient, and effective human services, which improve the lives of people North Dakota Department of Human Services Children and Family Services Division 600 E. Boulevard Avenue, Dept. 325 Bismarck, ND 58505-0250 Phone: (701) 328-2316 Toll Free: (800) 245-3736 Relay ND TTY: 711 Fax: (701) 328-3538 Email: [email protected] Website: www.nd.gov/dhs Facebook: @NDHumanServices Twitter: @NDHumanServices 3

6 Child Welfare SystemContents 16 Child Protection Services 24 Permanency Services 34 Well - Being Services 38 Early Childhood Services 42 Fact Sheets 48 Data Figures 4

From the Division Director Cory Pedersen, Director Children and Family Services Division Address: 600 E. Boulevard Ave., Dept. 325 Bismarck, ND 58505-0250 Phone: 701.328.2587 Email: [email protected] Web: www.nd.gov/dhs/services/childfamily Welcome to our SFY 2020 edition of Children and Family Services: By The Numbers. Change Happens! Often times we find that people want to see change but don’t necessarily want to be a part of. People tend to fear change because of the uncertainty that can go along with it. Author C. JoyBell C. wrote, “We can’t be afraid of change. You may feel very secure in the pond that you are in, but if you never venture out of it, you will never know that there is such a thing as an ocean, a sea. Holding onto something that is good for you now, may be the very reason why you don’t have something better.” The child welfare system in North Dakota is in the midst of some very big changes…changes that are and will continue to result in better outcomes for children and families across North Dakota. It would be easy for us to shy away from letting go of the familiar. Instead, we have embraced the change and children and families are reaping the rewards. As you look through this publication, you will see the Division and its stakeholders are making great strides yet challenges still remain. To paraphrase Henry Ford, “If everyone is moving forward together, then success will take care of itself” and we will continue to realize our goal of Safe Children and Strong Families. 5

Child Welfare System Safe Children ~ Strong Families “Anyone who does anything to help a child is a hero to me.” — Fred Rogers, television personality 6

Child Welfare Services in North Dakota responsible for administering Title IV-B of the Social Security Act, Child Welfare Child welfare in North Dakota is a Services, CAPTA, and the Chafee Foster Care complex system comprised of a myriad Independence Program Plan. The Children and of private and public stakeholders, Family Services (CFS) Division has administrative each with their own mission but all sharing one responsibility for the Child and Family Services common goal: Plan, the policies and procedures relating to children and families, and for program Ensure Children are Safe supervision and technical assistance for the delivery of public child welfare services. and Families are Strong The North Dakota Department of Human The Children and Family Services Division Services’ (ND DHS) Children and Family oversees the public child welfare system in North Service Division (CFS) has administrative Dakota and administers programs to ensure: 1) responsibility for programmatic supervision and Children are, first and foremost, protected from technical assistance for the delivery of public abuse and neglect and are safetly maintained in child welfare services. North Dakota is a state- their homes whenever possible and appropriate; supervised, county administered child welfare 2) Children have permanency and stability system divided into 19 human service zones with in their living situations and the continuity of 53 counties (map below). their family relationships and connections are preserved; and 3) Families have enhanced The North Dakota Department of Human capacity to provide for their children’s needs Services has been designated by the Governor and children receive adequate services to meet of North Dakota as the single state agency their social/emotional, educational, physical Figure 1: Human Service Zones Source: North Dakota Department of Human Services 7

Figure 3: Organizational Chart: Children and Family Services Division Source: North Dakota Department of Human Services 8

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and mental/behavioral health needs. Team Decision Making (FTDM), and Early Childhood Services. The CFS Division administers child protection, foster care, adoption, and family preservation Direct services are provided by human service services. These include child abuse and zones or through contracts with nonprofit and neglect prevention and intervention, Children’s tribal providers. The Division, direct service Trust Fund, Community-Based Grants for providers, and other system partners such as the the Prevention of Child Abuse and Neglect court and behavioral health systems make up the (CBCAP), Child Fatality Review Panel, backbone of the North Dakota Child Welfare Institutional Child Protection Services, criminal System. The system wraps services around the background checks, Interstate Compact on child and the family and works towards its the Placement of Children, Foster Care Case mission of Safe Children ~ Strong Families. Management, Refugee Services, Independent Living Services, Subsidized Guardianship, Division Funding Adoption Services, Subsidized Adoption, in- home case management services, Parent Aide The Division’s funding is focused on the services, Prime Time Child Care services, Respite mission of keeping children safe and Care services, Safety/Permanency Funds, families strong. About 91% of the Division’s Intensive In-Home Family Therapy services, budget it in the Grant Line, used to fund the Family Group Decision Making (FGDM), Family child welfare programs across the state. Salary Figure 4: North Dakota Child Welfare System Source: Children and Family Services Division 10

makes up 5% of the Division’s budget, while modifications are costly and time consuming. Operating makes up 4%. Approximately 54% CFS program administrators must rely on DSS of the budget is Federal funding. analysts and other ITS staff to extract information from the system. The system is not streamlined Social Service Redesign resulted in the Division for the frontend user and requires a considerable absorbing many employees from human service amount of time to enter pertinent clinical zones and regional human service centers, information. The system is not structured to including daycare licensing staff and regional minimize data errors and efforts to correct errors supervisors. The Division operates with 73 take considerable effort and resources. employees. Costs to maintain these systems are: Child Welfare Information System: Much Needed Overhaul Would Reap • FRAME monthly costs (includes hosting and Systemwide Benefits development): $62,000 The child welfare system in North Dakota • CCWIPS monthly costs (includes hosting and relies on two information technology development): $41,000 solutions for its primary case management and payments system: FRAME and the • Frame data fixes average monthly cost: Comprehensive Child Welfare Information and $9,155 Payment System (CCWIPS). While both systems may have served their purpose when designed, • Total Monthly Costs: $112,155 ($2,691,720 they struggle to meet the needs of the state’s biennially) rapidly changing child welfare system. Both systems lack robust data integrity functions CCWIPS is a mainframe-based system that and methods designed to minimize data errors has been in existence for well over 30 years. and efforts to correct errors take considerable System modifications to allow for the extraction time and resources. Rudimentary consistency of data are costly and time consuming. During checks are present but generally not designed 2019, the Children and Family Services Division in a proactive method to reduce data entry submitted a work order to add two payment and leverage existing data to algorithmically codes to the system. The total cost estimate was facilitate compute-ahead data capture. in excess of $100,000 and would require up to a year to complete. Extracting data requires Extracting data requires a work order for a work order to the Information Technology extraction assistance as DHS program Division as DHS program administrators and administrators have limited access and Decision Support Services analysts do not have capability to perform this function themselves. access nor the ability to perform this function. Similarly, data fixes require a work order to IT and are costly and time consuming. The The FRAME system was implemented in 2009 following chart show the number of data fixes and serves as the case management data submitted for the past 4 years. system for county social services as well as the primary data system for federal child FRAME reporting has the building blocks for a welfare reporting. Similar to CCWIPS, system more robust data analytics posture but to date, is not fully realized due to a lack of cohesive design and execution of in-system methods. A significant amount of work is required to establish and build out required federal data 11

Figure 5: Data Requests: CY 2017-CY 2020 required elements of a modern system: • Operations (general performance, cases entered, consistency checks, etc.) • Operational (day to day case management related information for field staff) • Longitudinal (month-to-month, year-to-year, statewide, trend analysis, cost projections, staffing, etc.) • Federal compliance (for submissions, data analysis based on federal requirements, case management for compliance, etc.) Source: North Dakota Information Technology Both FRAME and CCWIPS either lack these components in their entirety or contain a compliance outputs that would be required to rudimentary set that is not adequate based be included with a new system. The system on contemporary systems within DHS or other was not designed with the ability to purge files, States. as well. Not only does this cause issues with record retention, the growing amount of data Both systems have integration points to share that is being stored has begun to negatively data and enable cross system functions that impact data extraction and reporting by causing altogether make up the primary data system for unforeseen errors. As a result, the Department CFS. Neither system, however, can share data is at growing risk of being noncompliant with between other system, such as SPACES, MMIS, federal requirements which could result in fiscal or outside data system such as the Supreme sanctions. Courts information management system. This makes ongoing data sharing and working Modern system design incorporates enhanced across state government branches and executive data capture methods, think-ahead system logic, agencies exceedingly difficult. document-based data capture methods, and flexible yet minimal redundant data entry. The intent of a new system would be purchase Use of extensible Business Rules engines and or transfer a Comprehensive Child Welfare Workflow Designers in modern systems enable Information System (CCWIS) system that a more adaptive configuration posture for integrates all functions for Child Welfare using Federal Rules changes instead of a build as the best of breed approach. This would also needed approach currently employed. In include compliance with federal requirements general there is at least one large rule revision and ongoing system upgrade/modifications for each year across CFS’s regulatory scheme, and new or revised regulations. This will enable a in some years, multiple. This work requires a lot more favorable cost allocation and functional of business and IT to scope out changes to the support for child welfare. data capture as well as reporting (operationally and compliance). The Family First Act Prevention Services Act of 2018 requires that all states join the national The following Reporting contexts are basic electronic interstate system for processing Interstate Compact on the Placement of Children (ICPC) cases by 2027. The National Electronic 12

Interstate Compact Enterprise (NEICE) is the Dr. Jerry Millner, Associate Commissioner at the only system nationwide meeting this description. Children’s Bureau, noted that, “The presence of It is a national electronic system for quickly poverty alone does not mean a child is unsafe, and securely exchanging all the data and unloved, or that a parent lacks the capacity to documents required by the ICPC to place care for his or her child. Poverty can make it children across state lines. Implementing a new more challenging for parents to meet certain of information system would allow North Dakota their children’s needs. We must be resoundingly to implement NEICE within in it and meet federal clear that a child should never be removed requirements. from his or her family due to poverty alone.” During his address at the closing plenary of The National Vision: An Old Call for a the 21st National Conference on Child Abuse New Way and Neglect, Dr. Millner stated, “Most of our families...need help combatting the poverty The President of the United States convened they are experiencing. They need help with a conference in Washington, DC on the their own youth and the limitations of their own care of dependent children. In attendance inexperience. They need help with their social were representatives from nearly every state in isolation and their lack of accessible supports. the country. The conference keynote message And we need a system where they have a voice expressed that, “Home life is the highest and in expressing what they need and how those finest product of civilization. Children should needs can best be met.” not be deprived of it except for urgent and compelling reasons.” The President noted, The messages are consistent but it doesn’t “Surely poverty alone should not disrupt the appear that the actions have changed much in home. Parents of good character suffering from just over111 years. temporary misfortune, and above all deserving mothers fairly well able to work but deprived of Family First and System Redesign: New the support of the normal breadwinner, should Focus - New Futures be given such aid as may be necessary to enable them to maintain suitable homes for the Nationwide, there are just under a half- rearing of their children. million children in foster care. This has vacilated during the past 30 years. In The first conclusion drawn from the conference 1990, there were around 400,000 children was that children should, “...as a rule, be in out-of-home care. The number climbed to kept with their parents at home. The second 567,000 by the end of the decade. At it’s most conclusion highlighted the need for preventive recent lowerst level, the number dropped to work in that, “The effort should be made to 397,000 in 2012. There was a steady climb eradicate causes of dependency, such as during the next five years to a level of 441,000 disease and accident...” children in 2017. Alarmed by the rise, Congress stepped in. The President who convened the conference was Theodore Roosevelt and it was held January 25- The Family First Prevention Services Act of 2018 26, 1909. was signed into law as part of the Bipartisan Budget Act on February 9, 2018. This act reforms Jump ahead to 2019. the federal child welfare financing streams, Title 13

IV-E and Title IV-B of the Social Security Act, The approved evidence-based programs to allow states and tribes to access additional eligible for Title IV-E reimbursement include federal funding to support front-end prevention Healthy Families, Parents as Teachers, Nurse- services. Other provisions of the law include Family Partnership, Homebuilders, Brief Strategic reducing placements of children in residential Family Therapy, Parent-Child Interaction care, expanding supports for youth transitioning Therapy, Multisystemic Therapy and Functional to adulthood, promoting kinship and relative Family Therapy. placements, as well as other enhancements to strengthen the child welfare system. The Department continues to redesign the social service delivery system across North Dakota, One large piece of the federal legislation was including child welfare services, using Theory of the transformation of residential child care Constraints (TOC). TOC is a methodology for facility providers into qualified residential identifying the most important limiting factor (i.e. treatment providers (QRTP). This higher level constraint) that stands in the way of achieving of care must use a trauma-informed treatment a goal and then systematically improving that model and employ registered or licensed constraint until it is no longer the limiting factor. nursing staff and other licensed clinical staff to The primary focus of TOC is to identify the meet the treatment needs of children in out-of- constraints, believe there is hidden capacity, and home placement. The department also secured apply the “rules of flow” to measure the work a contract with a third-party vendor to complete output and the quality of work. assessments and to approve or deny placements into the QRTP level of care. The first child welfare program to go through redesign was Child Protection Services. Three North Dakota was one of the first 11 states to goals were identified as part of the CPS fully implement the provisions of FFPSA prior to redesign project: the October 2019 deadline. 1. Reduce the time it takes to complete a CPS In August of 2020, North Dakota became the assessment. seventh state in the country to receive approval 2. Conduct a face to face meeting with the of its Family First Title IV-E Prevention Services and Programs Plan from the federal Children’s identified child within 3 days. Bureau, an office of the Department of Health 3. Conduct complete casework 100% of the and Human Services’ Administration for Children and Families. time, only passing on completed casework. North Dakota’s prevention plan allows the state Statute requires CPS assessments to be to access federal Title IV-E funding for evidence- completed within 62 days. Prior to redesign, that based prevention services for children and occurred only 48%. Redesign work set new families who are at risk of entering the foster targets of: care system. Services include both mental health and substance abuse treatment and recovery • 50% of CPS assessments completed at 25 support services as well as in-home parent skill- days based programs that are designed for parents of young children. • 75% of CPS assessments completed at 35 days • 95% of CPS assessments completed at 62 days When implemented, the new CPS process 14

resulted in: as well as changing our plans as family • 89% of the cases closed with 62 days needs change; 3. Continually assess the appropriateness of (baseline was 40.8%) out-of-home placement/safety plans and • 56% of closed cases were closed within 25 return children to the home when it is safe to do so, rather than waiting for court orders to days (baseline was 7.35%) expire; • 89% of CPS workers met face-to-face with 4. Consistency of practice from agency to agency and worker to worker; and the identified child within three days of the 5. Consistent understanding of safe vs. unsafe report, sooner if imminent concerns were so that decision making is more uniform identified across the state. During redesign work for In-Home Case Management, it became apparent that a change in practice was needed. Case review data and federal data profiles showed: 1. We were not completing accurate/ comprehensive assessments of child safety and not implementing responsive, sustainable safety plans; 2. Children and parents/caregivers are not provided with comprehensive assessments of their needs and aren’t receiving appropriate services during case management; 3. Children remain in foster care for lengthy periods of time and we have challenges achieving permanency goals; 4. Agencies do not practice consistently, nor do workers within the same agencies; and 5. We haven’t had an agreed-upon definition of safe vs. unsafe and as a result decision making around child safety and removal is widely variable. As a result of this redesign work, North Dakota is in the process of implementing the Safety Framework Practice Model. This model provides the child welfare system with tools that will: 1. Support comprehensive safety assessments and appropriate/sustainable safety plans; 2. Prompt us to focus on parent/caregiver protective capacities and impending danger in order to provide a strong practice framework so that needs are accurately assessed and appropriate services provided, 15

Child Protection Services Children are, first and foremost, protected from abuse and neglect. “Safety and security don’t just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear.” — Nelson Mandela, Former President of South Africa 16

Protecting Our Future some believe their only purpose is to take children away from their parents. That is far Children are our most precious resource. from the truth. While there are instances when Children are our future. Children children must be removed from their homes deserve a life free from violence and for their safety, Child Protection Services is fear. These beliefs are what drives the child committed to finding safety for the child within welfare system. the homes. Removal of the child is only the last resort when all other options have been North Dakota’s Child Protection Services explored. program was designed to make these reality by: What the Numbers Say • Protecting the health and welfare of children by encouraging the reporting of children The federal Children’s Bureau found in who are known to be or suspected of being 2017 that approximately 4 million referrals abused or neglected were made to child protection agencies nationally for alleged child maltreatment. These • Providing adequate services for the involved 7.2 million children with 683,000 of protection and treatment of abused and them verified as being victims of maltreatment. neglected children and to protect them from Just over three-quarters were victims of neglect, further harm 17.2 percent were victims of physical abuse, and 8.4 percent were victims of sexual abuse. • Identifying the cause of children’s deaths, where possible; Identify circumstances In North Dakota, just under 17,000 reports that contribute to children’s deaths; and of suspected child abuse and neglect were recommend changes in policy, practices, received in FFY 2019. From those reports, and law to prevent children’s deaths just under 1,800 victims were identified. This represents about 1.0 percent of North Dakota’s When people hear of Child Protection Services, Figure 6: Reports of Suspected Child Abuse and Neglect, FFY 2010 - FFY 2019 16,733 18,000 1,797 FFY 2019 16,000 15,676 16,457 14,000 12,000 13,700 14,332 2,097 10,000 FFY 2018 12,392 11,442 10,771 9,540 9,840 8,000 6,000 4,000 1,517 1,688 1,760 1,911 2,064 2,000 1,134 1,295 1,402 0 FFY 2011 FFY 2012 FFY 2013 FFY 2014 FFY 2015 FFY 2016 FFY 2017 FFY 2010 Reports of Suspected Child Abuse and Neglect Child Victims of Abuse and/or Neglect Source: State-specific National Child Abuse and Neglect Data System (NCANDS) Data 17

Are You a Mandated Reporter? ; Physician, Nurse, Dentist, Optometrist, Dental Hygienist, Medical Examiner, Coroner, Or Any Other Medical Professional ; Mental Health Professional ; Religious Practitioner of The Healing Arts ; School Teacher or Administrator, School Counselor ; Addiction Counselor ; Social Worker ; Family Services Specialists ; Any Child Care Worker ; Foster Parent ; Childcare Licensors ; Police or Law Enforcement Officer ; Juvenile Court Personnel, Probation Officer, Division of Juvenile Services Employee ; Member of The Clergy ; Any Person Having Reasonable Cause to Suspect That a Child is Abused or Neglected, or Has Died as a Result of Abuse or Neglect, May Report Such Circumstance “We all play a roll in keeping children safe.” Marlys Baker, CPS Administrator Children and Family Services Division 18

child population. Figure 7: Type of Maltreatment, FFY 2010 - FFY 2019 Psychological Maltreatment Neglect Sexual Abuse Physical Abuse 5883 4861 5536 4514 4588 5109 4688 4641 4815 4913 3842 3031 2618 2392 2302 2315 2812 2287 2397 2553 1710 1769 1659 1640 1543 1520 1580 1802 1688 1370 227 292 291 FFY 2017 FFY 2018 FFY 2019 241 260 283 273 250 239 202 FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 FFY 2015 FFY 2016 Source: State-specific National Child Abuse and Neglect Data System (NCANDS) Data A further look into the data shows that Neglect is the most numerous type of maltreatment found. When instances of known or suspected child abuse or neglect occur within state institutions responsible for the child’s welfare such as a residential child care facility, a public or private residential educational facility, a maternity home, or any residential facility owned or managed by the state or a political subdivision of the state, it is the responsibility of Institutional Child Protection Services to become involved. Field Services Specialists conduct the assessments and report the funding to the State Child Protection Team. The Team is made up of members from the following agencies: Department of Public Instruction, Department of Corrections, Developmental Disabilities Division, Residential Facility Licensors, Office of the Attorney General, Children and Family Services-Child Protection, and the Behavioral Health Division. Through review of the assessments, they determine if child abuse or neglect is indicated or not indicated. The team may issue reports or recommendations on any aspect of child abuse or neglect, when deemed appropriate. Substance Exposed Newborns During the 2017 State legislative session, the state Child Abuse and Neglect Chapter was amended, allowing for an Alternative CPS assessment response to reports of substance 19

Figure 8: Institutional CPS: Type of Maltreatment, CY 2015 - CY 2019 14 170 154 147 180 12 160 520000 712000 140 10 CY 2017 102 CY 2019 120 Neglect: Inadequate Supervision 100 Neglect: Medical 107 201010 80 Neglect: Other 8 CY 2018 60 Pyschological Maltreatment 40 Physical Abuse 6 20 Sexual Abuse 0 Total number of reports received 4 2 13 0 4 1 2 0 CY 2016 11 0 1 4 1 1 0 CY 2015 Source: ICPS Database exposed newborns. An alternative response services can result in completion of a standard assessment wraps supports and services around CPS assessment response. substance exposed newborns and parents if the parents want to work towards recovery from In FFY19, there were 45 completed Alternative substance use while keeping their newborn safe Response Assessments for Substance Exposed at home. When county social services receives Newborns and an additional nine Alternative a report that a newborn has been affected by Response Assessments were terminated in drug use (legal or illegal), has symptoms of progress per policy. Reasons for terminating withdrawal from a substance (legal or illegal), an assessment of suspected prenatal substance or has a Fetal Alcohol Spectrum Disorder, exposure include: social services is required by law to complete • An infant has been affected by medical use an assessment. Parents who qualify can choose either an alternative response assessment or a of a substance, which causes withdrawal standard child protection services assessment. symptoms in the infant. Medical use has The state law new defines a “Substance been verified and the parent declines Exposed Newborn” as an infant younger than Alternative Response. 28 days of age at the time of the initial report • The baby is released for adoption and of suspected child abuse or neglect and who is parental rights are terminated identified as being affected by substance abuse • Information gathered during the assessment or withdrawal symptoms or by a fetal alcohol indicates the newborn was not substance spectrum disorder.” The state law requires exposed (confirmatory test results vs referral services that address the health and screening test results, for example) treatment needs of the infant and affected family or caregiver through the creation and monitoring There were 214 unique substance exposed of support services through a Plan of Safe Care, newborns (neonates 28 days or younger) mirroring the federal CARA legislation amending reported / identified to child protection services CAPTA. State statute also provides that non- in FFY19. Of these 214 identified newborns, 176 compliance with the Plan of Safe Care or referral were known to have Plans of Safe Care (82%). The most frequently identified reasons for lack of 20

a Plan of Safe care included: drug testing done with a “heads up” when a child has been to confirm screening results was negative(child identified by law enforcement at the scene of not drug exposed); confirmed prescribed a traumatic event. The school then responds medication (voluntary services offered); case with interventions to help mitigate the trauma transfer out of jurisdiction (primarily tribal/ • Authentic Voices is a membership-based ICWA). group of survivors of childhood maltreatment for child victim advocacy. An Ounce of Prevention: Shaping Our • The Period of Purple Crying initiative, Future by Preventing Child Maltreatment an evidence-based infant abusive head trauma prevention program is available Child maltreatment has lasting negative to all birthing hospitals across the state for impacts on the health and mental health distribution to new parents. outcomes of children. What happens to children now shapes their lives in the future. It Improving Systems and Preventing also impacts our future as a society. Deaths: The Child Fatality Review Panel A history of maltreatment of a child has been Unexpected infant, child and adolescent linked to negative impact of brain development, deaths are tragedies that impact poorer lung function, and higher risk for individuals, families, communities. As things like heart problems. Psychological noted by the National Center for Fatality Review consequences can also develop as a result of & Prevention, the review of such deaths allows maltreatment including diminished executive for the “...telling of each person’s death in order functioning and cognitive skills, higher risk for to understand how and why the death occurred depression, and increased incidence of post- in order to take action to improve systems and traumatic stress. prevent deaths.” Society pays the costs for child abuse The North Dakota Child Fatality Review Pane, and neglect through direct costs such as a state level multidisciplinary panel organized hospitalization and foster care costs to indirect under state statute and supported through the costs such as loss of productivity and long- state child welfare agency, is responsible for term care. A study by the Centers for Disease reviewing all child deaths in the state. Using Controll and Prevention found estimated that data from Vital Records death certificates issued annual nonfatal costs of child maltreatment by the state for deaths of all children from birth exceed $428 billion in the United States. to age 18, the group performs an indepth review of any death in which the manner of Quality preventative services have been shown death is indicated as “Accident”, “Suicide”, to help decrease the incidents of child abuse “Homicide”, “Undetermined” or “Pending and neglect and thus the overall physical, Investigation.” Death certificates in which the behavioral health, and societal costs. North manner of death is indicated as “Natural” are Dakota, working with Prevent Child Abuse of reviewed to determine whether the “Cause of North Dakota, has implemented a number of Death” listed on the death certificate qualifies as prevention programs including (but not limited “sudden, unexpected, or unexplained”. These to): deaths, then, are also selected for in-depth • Handle with Care: Provides the school review by the Panel and include all deaths where the cause of death is SIDS or SUID. 21

Additionally the Child Fatality Review Panel coordinates with the state Medical Examiner’s Office, law enforcement agencies and medical facilities, statewide to accomplish these reviews. Child Protection Services is the entity that labels a child death as to whether the death is the result of “child maltreatment”. There is no corresponding “child maltreatment” label used by the State Medical Examiner’s Office, law enforcement agencies or medical facilities. Medical Examiners label the manner of deaths as “Homicide, Suicide, Accident, Natural and Undetermined”. Law enforcement may label the death as a criminal charge such as: “murder, manslaughter, negligent homicide”, etc. and medical doctors label deaths with medical diagnoses such as “cardiac arrest” or “blunt head injury”, none of which indicate whether child maltreatment was the cause or manner of death. While it is a certainty that a homicide or murder is an intentional act, there are no data elements contained in medical, law enforcement or forensic records to indicate the relationship of the individual responsible for the act upon the child in order to determine whether a child death is a “maltreatment death” at the hands of a caregiver, under the state Child Abuse and Neglect law, or an act of violence committed by a stranger. A “blunt head injury” may or may not be intentional, such as vehicle crash or fall injuries. 22

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Permanency Services Children have permanency and stability in their living situations. “I continue to believe that if children are given the necessary tools to succeed, they will succeed beyond their wildest dreams!” — David Vitter, Former U.S. Senator 24

Permanency For Every Child rights and adoption becomes the option. Every child deserves a safe, permanent Who is in Foster Care place to live. Idealy this is with parents and siblings. There are times, however, when Nationally, just under a half-million out-of-home care (foster care) is needed to children are in out-of-home care. This protect the child. equates to a rate of 5.68 per 1,000 children (see Figure 9). Foster care is a temporary service, providing a safe placement option for children who cannot Figure 9: National In Care Population Change live with their families. This placement can be with relatives or unrelated foster parents. It can also be in a group home, qualified residential treatment facility, emergency shelter, or supervised independent living. Foster care, however, should not be considered Source: State-submitted AFCARS data, Claritas Population Data a permanent option for a child. The Adoption and Safe Families Act (ASFA) of 1997 calls for North Dakota followed the general trend of the five permanency options for children removed Nation, however had a rate per 1,000 higher from the home: than the national rate. • Reunification with the parent • Termination of parental rights and adoption Figure 10: North Dakota In Care Population Change • Guardianship with a permanent guardian • Guardianship with a “fit and willing relative” while remaining in the States’ legal custody • Another planned permanent living arrancement (APPLA) while remaining in the State’s legal custody. Every effort is made to reunify the child with Source: State-submitted AFCARS data, Claritas Population Data the parents. Case workers provide or arrange for a myriad of services to address the issues North Dakota point-in-time data shows that that resulted in the removal. These can include -- on July 1, 2020 -- the “typical” child in foster parent education, evidence-based mental care was a Native American (45%) male (53%) health or substance use disorder services in who was 2 years old and had been in care the community, and connection with economic for just under 2 years. Further, AFCARS data assistance programs. There are times, however, shows that American Indian/Alaska Native is when aggrevated circumstances exist that overrepresented in the foster care population as prevent reunification from occuring, such as when a parent has caused great bodily injury to a child or caused the death of a sibling to the child. In those cases, termination of parental 25

Figure 11: Typical Child In Out-of-Home Care Figure 12: North Dakota General Child Population by Race on July 1, 2020 1% Male 5% 2 Years Old 8% Native American Asian/NHPI 7% In Care for Multi-racial 644 Days AIAN 5% Latino(a)/Hispanic Black/AA 74% White Source: State-submitted AFCARS data, Claritas Population Data Source: FRAME Point-in-Time Data: July 1, 2020 Figure 13: North Dakota Foster Care Involvement by Race 100% 90% White 80% 41% 39% 35% Black/AA 70% 52% Latino(a)/Hispanic AIAN 60% 3% 5% 4% Multi-racial 6% Asian/NHPI 6% 50% 7% 40% 10% 3% 30% 41% 40% 44% 20% 31% 10% 9% 10% 4% 7% 0% Children Entering Children in Care Children in Care Youth Aging Out Care 2+ Years Source: State-submitted AFCARS data, Claritas Population Data 26

it only makes up about 8% of the general child population (see Figure 13). Drivers of In-Care Counts One can argue there are many reasons for increases in the number of children in out-of-come placement. At its simplest level, however, it is a result of more children coming into care than there are children exiting from care. In the previous 3 federal fiscal years, entries outpaced exits on average of 160 children per year. Entries for Native Americans outpaced others by at least 3 to 1. Figure 14: Number of Entries and Exits by Federal Fiscal Year Source: State-submitted AFCARS data, Claritas Population Data Figure 15: Number of Entries by Race and Federal Fiscal Year Source: State-submitted AFCARS data, Claritas Population Data 27

How Long are Children in Care? permanency within 12 months of the first day? In North Dakota, this was 26.8 percent in FFY 2019 The Adoptions and Safe Families Act of (FIgure 18). 1997 requires permanency hearings to be held within 12 months after a child enters Figure17: Of all children in care on the first day of a care and at least every 12 months thereafter. The 12-month period who had been in care continuously goal is to prevent children from languishing in between 12 and 23 months, the percent discharged to care. Nationally, 42.7 percent of children are permanency within 12 months of the first day? discharged to permanency within 12 months of entering care. in care with no movement towards 50.0% Na ti onal Benchmark: 45.9% a permanent placement. As can be seen in Figure 45.0% 16, North Dakota falls just below the national benchmark. Statistically, though, this is considered 40.0% no different than national performance. 35.0% 30.0% 25.0% The farther out we go from the time a child 20.0% 31.9% 32.9% 35.7% first enters care, state performance drops off. 15.0% Nationally, of all children in care on the first day of a 12-month period who had been in care 10.0% continuously between 12 and 23 months, 45.9 percent are discharged to permanency within 5.0% 12 months of the first day? In North Dakota, the percentage was 35.7 percent in FFY 2019 0.0% (Figure 17). Similarly, of all children in care on the first day of a 12-month period who had been FFY 2017 FFY 2018 FFY 2019 in care continuously for 24 months or more, 31.8 percent nationally were discharged to Source: Children’s Bureau, Child and Family Services Review (CFSR 3) Data Profile, August 2020 Figure 18: Of all children in care on the first day of a 12-month period who had been in care continuously for 24 months or more, the percent discharged to permanency within 12 months of the first day? Figure 16: Of children who enter care in a 12-month 50.0% period, the percent discharged to permanency within 12 months of entering care? 45.0% 50.0% 40.0% 45.0% Na ti onal Benchmark: 42.7% 35.0% 40.0% 30.0% Na ti onal Benchmark: 31.8% 35.0% 25.0% 30.0% 20.0% 25.0% 40.7% 40.8% 41.0% 15.0% 26.0% 28.1% 26.8% 20.0% 10.0% 15.0% 5.0% 10.0% 0.0% 5.0% FFY 2017 FFY 2018 FFY 2019 0.0% Source: Children’s Bureau, Child and Family Services Review (CFSR 3) Data Profile, August 2020 FFY 2015 FFY 2016 FFY 2017 Source: Children’s Bureau, Child and Family Services Review (CFSR 3) Data Profile, August 2020 28

Where are Children Placed Children tend to do best when they live in a home setting with There are a number of placement options familiar surroundings and people available to children who are in out-of-home they know. care. Placement can be with relatives or unrelated foster parents. It can also be in a group Dean Sturn, Foster Care Administrator home, qualified residential treatment facility, Children and Family Services Division emergency shelter, or supervised independent living. Of all children in care on 9/30/2019, most were in a foster care setting while about 1 in 5 were in a kinship care setting. Kinship care is preferred in that it places the child with relatives who provide a sense of belonging to a child and help Figure 19: Placement Setting Type (9/30/2019) Source: State-submitted AFCARS data, Claritas Population Data maintain family connections. One in 10 children were placed in a congregate care setting such as a Qualified Residential Treatment Program (QRTP) or a Psychiatric Residential Treatment Facility (PRTF). The Federal Administration for Children and Families (ACF) noted in 2015: “Although there is an appropriate role for congregate care placements in the continuum of foster care settings, there is consensus across multiple stakeholders that most children and youth, but especially young children, are best served in a family setting. Stays in congregate care should be based on the specialized behavioral and mental health needs or clinical disabilities of children. It should be used only for as long as is needed to stabilize the child or youth so they can return to a family-like setting.” 29

Children are best served in a family setting. This Figure 20: Number of Licensed Foster Homes makes recruiting and retaining licensed foster homes vital. In January 2020, the Department 1,200 1,111 1,060 1,034 1,019 engaged in a formal contract with the University 1,000 of North Dakota Children and Family Services 975 1,013 1,014 1,016 1,022 1,014 1,027 1,025 Training Center (CFSTC) to hire a Foster Care Recruitment Retention Specialist (FPRRS) to lead 846 a statewide recruitment and retention effort. The following figure shows the number of licensed 800 foster families during the previous and current bienniums. 600 Out-of-State Placements on the Decline 400 Being removed from the home and placed 200 with people they may not know can be traumatic for children. Add to that being 0 placed hundreds or thousands of miles from those they know simply because the needed services Source: Manual count of foster homes licensed by CFS. cannot be found within the state. Practices that were initially designed to benefit the child can The state has worked hard to decrease the actually cause more trauma and future difficulties number of children placed out-of-state. More for them. relative caregivers have been found. There is an ever-increasing focus on family foster care settings rather than congregate care. Training/ additional supports allowing in-state facility providers to accept youth with higher needs. Since January of 2016, the number of children placed out-of-state in a residential child care facility has decreased by 95%. Figure 21. Number of Children in Out-of-State Congregate Care Placement by Type for the Period January of 2016 to July of 2020. 50 45 40 43 35 30 26 25 23 20 21 16 15 13 10 17 11 10 12 10 14 14 7 2 5 99 Jan-20 3 7 2 Jul-20 0 Jan-16 Jul-16 Jan-17 Jul-17 Jan-18 Jul-18 Jan-19 Jul-19 Source: ICPC Deputy Administrator: ManuRael scidoeunntitaol fCchhilidldCreanreinFaocuilti-tioesf-state congPresygcahtieatrcicarReespidlaecnetiaml eTnretas.tment Facilities 30

Transition-Aged Youth Provided a administers the Chafee Program grant and Number of Opportunities for Success oversees the Regional Chafee and Education and Training Voucher (ETV) Programs across the Most young people make the transition state. Nexus - PATH Family Healing (formerly from adolescence to adulthood with referred to as PATH Inc.) is the Chafee Program the support of their biological families, statewide provider; the Chafee Transition communities, and schools. However, youth aging Coordinators are in all eight regional Nexus- out of foster care may lack family and social PATH Family Healing offices statewide. Chafee supports. As a result, foster youth face enormous Transition Coordinators deliver service to eligible challenges in making a smooth transition to current foster care youth and Foster Care Alumni adulthood and building successful lives. in all eight regions of the state. All youth who are at least 14 years of age, are not yet 23 The Chafee Foster Care Program for Successful years of age and who are or were in foster care Transition to Adulthood, including the Education after the age of 14 are eligible for components and Training Voucher (ETV) Program, provides of the Chafee Program. In addition, all youth in flexible funding to promote and support youth foster care, as well as foster care alumni Chafee who have experienced foster care at age 14 or participants, age 14 and older, are required to older in their transition to adulthood. Through have their independent living needs assessed. the Family First Prevention Services Act (FFPSA), The Chafee Program does not have a case load North Dakota has extend the maximum eligibility standard. Figure # shows the number of youth age and use Chafee funds to serve youth to age participing in CFCIP in North Dakota. 23, and ETV funds to serve young people to age North Dakota participates in the National Youth in Transition Database (NYTD), which collects 26, as allowed by FFPSA. information about the outcomes of youth who have aged out of foster care. States are required The North Dakota Department of Human to administer the NYTD survey to cohorts of youth at ages 17, 19 and 21. Figures 23 - 25 Services, Child & Family Service Division Figure 22. Number of Youth Participating in Chafee Foster Care Independence Program (CFCIP) in North Dakota: FY 2013-2019. Source: ND Department of Human Services 31

display outcomes for North Dakota youth in the areas of homelessness, enrollment in school, employment, incarceration, and given birth to or fathered any children. Figure 23. Cohort 1 and 2 Reponses Regarding Homelessness and School Enrollment Source: National Youth in Transition Database, FFY 2019 Figure 24. Cohort 1 and 2 Reponses Regarding Employment Source: National Youth in Transition Database, FFY 2019 Figure 25. Cohort 1 and 2 Reponses Regarding Incarceration and Children Source: National Youth in Transition Database, FFY 2019 32

When Children Exit from Care care in safe and healthy ways. Foster and birth families must work together to support children The need for strong relationships and in and after care to help ensure successful parental support continues when a child reunification. Every effort is made to reunify enters foster care. Children need to feel children with their parents. In fact, Figure 26 loved and cared for by their mothers, fathers, shows that nearly about half of the children in siblings, and maternal and paternal relatives. care are reunited with their parents. There are Even when parents are unable to keep their times, however, when reunification is not possible children safe at home, parents can remain and the child welfare system needs to seek actively involved with their children in foster alternatives such as adoption or guardianship. Figure 26. The Number/Percentage of Children Exiting Care during FFY 2019 to Setting Type Source: State-submitted AFCARS data Figure 27. Percentage of children who re-entered care within 12 months of their discharge? Unfortunately there are times when children will reenter care. One of the goals of the child 10.0% welfare system is to minimize or eliminate this from occurring. Nationally, just over 8% of 9.0% Na ti onal Benchmark: 8.1% children discharged from care reenter care 8.0% within 12 months. Over the past 3 fiscal years, North Dakota, North Dakota averaged 7.0% about 7.3% of children reentering care within 12 months of discharge. While this is slightly 6.0% below the national benchmark, statistically it is considered no different from national 5.0% performance. 4.0% 7.3% 7.5% 7.0% 3.0% 2.0% 1.0% 0.0% FFY 2015 FFY 2016 FFY 2017 Source: Children’s Bureau, Child and Family Services Review (CFSR 3) Data Profile, August 2020 33

Well - Being Services Families have enhanced capacity to provide for their children’s needs and children receive adequate services to meet their social/emotional, educational, physical and mental/behavioral health needs. “To every child – I dream of a world where you can laugh, dance, sing, learn, live in peace and be happy. ” — Malala Yousafzai, Nobel Prize Laureate 34

Keeping Children Safely in the Home reunification to prevent re-entry into foster care. One of the most important parts of the • Parent aide services are designed to child welfare system is the prevention improve parenting skills with parents who and early intervention focus of Family are at risk of abusing or neglecting their Preservation Services. Assisting families in crisis children, by reinforcing parents’ confidence by improving parenting and family functioning in their strengths and helping them to identify while keeping children safe is paramount if where improvement is needed and to obtain we are to decrease the number of out of home assistance in improving those skills. It uses placements. Congress recognized this and the relationship between the parent and the passed the Family First legislation, which allows parent aide as a tool to encourage, teach, states for the first time to use federal Title IV-E and assist parents. funding for prevention and early intervention • Safety/Permanency Funds are flexible services. funding available to human service zones for families who are having difficulty and The Division has several family preservations are at risk of their children being placed out programs, implemented to curtail the rising of their homes. number of children placed in foster care • Prime Time Child Care provides temporary including: childcare to children of families where child abuse and/or neglect have occurred • In-Home Case Management provides or there is a risk of it occurring. It gives supportive case planning services for parents an opportunity to attend counseling, families and children living in the home addiction treatment, or other needed at risk of foster care placement, and for services while their children are cared for in children returning to the home following a licensed facility. Figure 28. The Number of Children in Foster Care and the Number of Families Served by Intensive In-Home Case Management: FFY 2016 - FFY 2019 1800 1456 1553 1590 1499 1600 1026 1028 1221 1276 1400 1200 1000 800 600 400 200 0 FFY 2016 FFY 2017 FFY 2018 FFY 2019 Children in Foster Care Families in In-Home Case Management Source: FRAME 35

• Respite Care services provide temporary traditions. Unfortunately, kinship caregivers care of a child with special medical, aren’t often afforded the same resources and emotional, or behavioral needs requiring assistance as traditional licensed foster parents. time-limited supervision by a licensed foster parent or licensed child care. Respite care is Concurrent with the passing of the Family First intended to reduce stress and strengthen the Prevention Services Act of 2018, states were in-home placement. offered the opportunity to apply for federal grant funds to develop a program that could provide Keeping Families at the Center needed assistance to kinship caregivers. North Family Centered Engagement (FCE ) is Dakota applied for and received federal Kinship a facilitated team process that includes Navigator funding in FFY 2018. CFS contracted participation from parents/caregivers, with Lutheran Social Services of ND (LSS-ND) to research the needs of kinship caregivers in extended family members, children, service our state, as well as potential kinship navigator providers, child welfare professionals, juvenile programs operating in other states, and provide recommendations regarding key components court staff, community partners, and others of a kinship navigator program that could involved in a child’s life. The meetings have be implemented here. During this time it was only one purpose and that is to make critical decisions with families regarding the removal of expected that one or more kinship navigator children from their homes to the least restrictive programs submitted to the Prevention Services and safest placements that are in the best interest Clearinghouse for review would be approved as an evidence-based practice. When no of the children. programs were approved, it was decided that FCE was implemented in a select number of LSS-ND and CFS administrators would instead counties in 2018 and implemented statewide develop a website resource for kinship families. in 2020. To date, there have been 386 FCE KinshipND (https://kinshipnd.com/) was meetings and at the 6 month follow-up, just over launched in 2019. North Dakota is currently in the process of developing the Kinship Navigator 71% of children remain with their parents and program. Kinship Navigators assist relatives siblings. who take primary responsibility for the care of When Removal Occurs, Family is Best children who need a safe and stable placement in learning about, finding, and using programs When removal of children from their homes and services to meet the needs of the children must occur to assure safety, the first option is they are raising. The program also allows kinship to explore whether relatives or other important caregiver the better meet their own needs and people can provide care. This is referred to as to promote effective partnerships among public kinship care, which is the full-time care, nurturing, and private agencies to ensure kinship caregiver and protection of a child by relatives, members families are served. of their Tribe or clan, godparents, stepparents, New Opportunities for Prevention or other adults who have a family relationship to a child. There is typically increased stability North Dakota became the seventh state and reduced trauma for children when placed in in the country to receive approval of its kinship care. Children are also able to maintain Family First Title IV-E Prevention Services significant connections with family and cultural 36

and Programs Plan from the federal Children’s for two to seven-year old children and their Bureau, an office of the Department of Health parents or caregivers that aims to decrease and Human Services’ Administration for externalizing child behavior problems, Children and Families. increase positive parenting behaviors, and improve the quality of the parent-child North Dakota’s prevention plan allows the state relationship. to access federal Title IV-E funding for evidence- • Multisystemic Therapy: intensive family based prevention services for children and and community-based treatment program families who are at risk of entering the foster for youth 12 to 17 years old delivered in care system. Services include both mental health multiple settings. and substance abuse treatment and recovery • Functional Family Therapy: short-term support services as well as in-home parent skill- prevention program for at-risk youth and based programs that are designed for parents of their families. young children. The approved evidence-based programs eligible for Title IV-E reimbursement include: • Healthy Families: Home visiting program for new and expectant families with children who are at-risk for maltreatment or adverse childhood experiences. • Parents as Teachers: Home-visiting parent education program that teaches new and expectant parents skills intended to promote positive child development and prevent child maltreatment. • Nurse-Family Partnership: Home-visiting program that has specially trained nurses regularly visit first-time moms-to-be, who are 28 weeks or less, meet income requirements and continuing through the child’s second birthday. • Homebuilders: Provides intensive, in- home counseling and support services for families who have a child 0-17 years old at imminent risk of out-of-home placement or who is in placement and cannot be reunified without intensive in-home services. • Brief Strategic Family Therapy: structured family systems approach to treat families with children or adolescents 6 to 17 years old who display or are at risk for developing problem behaviors including substance abuse, conduct problems, and delinquency. • Parent-Child Interaction Therapy: program 37

Early Childhood Services Protecting and promoting child safety and well-being in child care settings “Only where children gather is there any real chance of fun.” — Mignon McLaughlin, American Journalist and Author 38

Quality Child Care for North Dakota ordinances. Families • Licensed Child Care Center: Child care Safe, dependable, and quality childcare is centers are licensed for at least 19 children vital to the wellbeing of today’s families. in a facility, with the actual license capacity Under N.D.C.C. § 50-11.1, the North determined by available space, staff to child Dakota Department of Human Services is ratios, and sometimes local ordinances. required to administer the licensure of Early • Licensed Preschools: Preschools provide Childhood Services (child care) and to develop educational and socialization experiences standards to regulate child care settings. This for children age two years to kindergarten responsibility falls to the Children and Family and may operate sessions for no more than Services Division. three hours per day. • Licensed School-Age Programs: School-age Licensing is one form of consumer protection. programs are licensed for at least 19 children Licensed child care offers parents the in a facility, with the actual license capacity knowledge that providers are regulated through determined by available space, staff to child standards and monitoring. Child care licensing ratios, and sometimes local ordinances. regulations are designed to protect and School-age programs offer services before promote child safety and well-being in child and after school, and sometimes on school care settings. Licensed child care providers are holidays and through the summer months. required to maintain at least minimum standards • Multiple License Facility: This type of related to: program has more than one type of license, such as a center and preschool. • Physical size of the facility • Safety features Illegal Care is defined as unlicensed provider • Cleanliness caring for more than three infants or six or more • Staff qualifications, including training children (of mixed ages). This type of provider is operating against the law and may be charged and background checks with a Class B Misdemeanor. • Staff-to-child ratios • Program requirements Child Care Aware of North Dakota, under contract with the Division, offers help in starting There are a number of licensing categories available to providers including: Figure 29. Number of Child Care Providers and Capacity in North Dakota: FY 2016 - FY 2020. • Licensed Family Child Care: Family providers may care for up to seven children 40000 31094 31838 32212 33219 33394 with no more than under the age of 24 35000 months, plus two additional school-age 30000 1349 1285 1255 1235 1184 children. 25000 20000 • Licensed Group Child Care: Group child 15000 care programs may be licensed in a home 10000 or a facility. Groups may be licensed for up to 30 children, with the actual license 5000 capacity determined by available space, 0 staff to child ratios, and sometimes local F Y20 16 F Y20 17 F Y20 18 F Y20 19 F Y20 20 Licensed Child Care Providers Provider Capacity Source: Child Care Aware of North Dakota 39

a licensed child care program. Step-by-step actions taken by the Lead Agency and child guides and information about the required care provider; Health and safety violations, state paperwork needed to become a licensed including any fatalities or serious injuries child care provider is available at: http:// that occurred at that child care provider; ndchildcare.org/start/. Child Care Aware Consumer-friendly and easily accessible of North Dakota also maintains a statewide information; and three years of results, where database of licensed child care providers, available. helping parents locate quality child care. • Development of a statewide electronic child care licensing system that will bring North New Licensing Data System for Dakota into compliance with federal regula- Enhanced Safety and Management tions, allow the state to monitor and track the licensing process more efficiently, and pro- North Dakota does not have a central data vide consumer-friendly and easily accessible system to track and monitor the child care information. licensing process and oversight of providers. Licensors and Field Services Specialists store If the North Dakota Department of Human Ser- and share information about licensing inspec- vices chose to do nothing to correct the issue, it tions, correction orders, health and safety, and could face: injuries or fatalities with the state office in a • Future audit findings series of spreadsheets. • Federal penalty of 5% of the Child Care and Internal audit recommendations and Federal Development Fund (total CCDF award is funding requirements necessitate implementa- $4.1 million) tion of an electronic licensing system. A 2015 Internal Audit of the Early Childhood Services The North Dakota Department of Human Ser- program recommended the development of a vices has been diligently working with stakehold- cohesive data system to help monitor and track ers to solve the identified issue. The Governor’s the licensing process. 2016 Child Care and Advisory Committee on Child Care Licensing Development Fund (CCDF) Final Rule – based Process encouraged development of a licensing on the Child Care and Development Block data system to move toward compliance with Grant Act of 2014 – requires states to meet the federal requirements and support the acquisition following: of the necessary personnel to provide the staff- • Development of a consumer-friendly and ing needed for an effective system (November of 2016). Governor Dalrymple included funding easily accessible website that ensures in his proposed biennial budget (2017-2019) the widest possible access to services for for development of a licensing data system. The families, including those who speak lan- 65th Legislative Assembly allocated $3 million guages other than English and persons to the North Dakota Department of Human with disabilities Services for the development of a data system to • Post provider-specific results of monitoring meet federal requirements. and inspection reports, including: Reports due to major substantiated complaints The Statewide Child Care Licensing System team about a provider’s failure to comply with drafted a Request for Information to health and safety requirements and other obtain information on child care licensing Lead Agency policies; Timely information management systems currently available and including: Date of inspection; Corrective the current market environment to allow for the procurement of a system that will best meet the 40

needs of North Dakota. This led to drafting/is- suing a Request for Proposal. GL Solutions, Inc. was awarded the contract and work is currently underway to design and implement the Child Care Licesening Data System. 41

42 Fact Sheets

FACT SHEET CHILD PROTECTION SERVICES In North Dakota during North Dakota’s Child Protection Services program is charged with: FFY 2019, there were nearly • Protecting the health and welfare of children by encouraging the reporting of 17,000 reports of suspected child abuse and neglect and just under children who are known to be or suspected of being abused or neglected; 1,800 victims were identified. • Providing adequate services for the protection and treatment of abused and There were 214 unique substance neglected children and to protect them from further harm; exposed newborns (neonates • Identifying the cause of children’s deaths, where possible; Identify circumstances 28 days or younger) reported/ identified to child protection that contribute to children’s deaths; and services in FFY19 in North • recommend changes in policy, practices,and law to prevent children’s deaths n Dakota. North Dakota. The Centers for Disease Control and Prevention estimate While there are instances when children must be removed from their homes for their annual nonfatal costs of child safety, Child Protection Services is committed to finding safety for the child within the maltreatment exceed $428 homes. Removal of the child is only the last resort when all other options have been billion in the United States. explored. For more information: The federal Children’s Bureau found in 2017 that approximately 4 million referrals were made to child protection agencies nationally for alleged child maltreatment. Children and Family Services Division These involved 7.2 million children with 683,000 of them verified as being victims of maltreatment. Just over three-quarters were victims of neglect, 17.2 percent were 600 E. Boulevard Avenue, Dept. 325 victims of physical abuse, and 8.4 percent were victims of sexual abuse. Bismarck, ND 58505-0250 Phone: (701) 328-2316 In North Dakota, just under 17,000 reports of suspected child abuse and neglect Toll Free: (800) 245-3736 were received in FFY 2019. From those reports, just under 1,800 victims were Relay ND TTY: 711 identified. This represents about 1.0 percent of North Dakota’s child population. Fax: (701) 328-3538 Neglect is the most numerous type of maltreatment found. Email: [email protected] An alternative response assessment wraps supports and services around substance exposed newborns and parents if the parents want to work towards recovery from substance use while keeping their newborn safe at home. North Dakota, working with Prevent Child Abuse of North Dakota, has implemented a number of prevention programs including (but not limited to): • Handle with Care: Provides the school with a “heads up” when a child has been identified by law enforcement at the scene of a traumatic event. The school then responds with interventions to help mitigate the trauma. • Authentic Voices is a membership-based group of survivors of childhood maltreatment for child victim advocacy. • The Period of Purple Crying initiative, an evidence-based infant abusive head trauma prevention program is available to all birthing hospitals across the state for distribution to new parents. 43

FACT SHEET PERMANENCY SERVICES Data shows (July 1, 2020) the Foster care is a temporary service, providing a safe placement option for children “typical” child in foster care was: who cannot live with their families. This placement can be with relatives or unrelated • Native American (45%), foster parents. It can also be in a group home, qualified residential treatment facility, • Male (53%), emergency shelter, or • Two years old, supervised independent living. • In care for just under 2 years. The Adoption and Safe Families Act (ASFA) of 1997 calls for five permanency op- AFCARS data shows American tions for children removed from the home: Indian/Alaska Native is • Reunification with the parent, overrepresented in the foster • Termination of parental rights and adoption, care population (40%) as it • Guardianship with a permanent guardian, only makes up about 8% of the • Guardianship with a “fit and willing relative” while remaining in the States’ legal general child population. custody, Since 2016, the number of • Another planned permanent living arrancement (APPLA) while remaining in the children placed out-of-state in a residential child care facility has State’s legal custody. decreased by 95%. The number of licensed foster homes in North Dakota has grown from 846 in 2017 For more information: to 1,019 today. Children and Family Services Division Of all children in care on 9/30/2019, most were in a foster care setting while about 1 in 5 were in a kinship care setting. Kinship care is preferred in that it 600 E. Boulevard Avenue, Dept. 325 places the child with relatives who provide a sense of belonging to a child and help Bismarck, ND 58505-0250 maintain family connections. One in 10 children were placed in a congregate care Phone: (701) 328-2316 setting such as a Qualified Residential Treatment Program (QRTP) or a Psychiatric Toll Free: (800) 245-3736 Residential Treatment Facility (PRTF). Relay ND TTY: 711 Fax: (701) 328-3538 Since January of 2016, the number of children placed out-of-state in a residential Email: [email protected] child care facility has decreased by 95%. 44 During FFY 2019, nearly half of children in foster care were reunited with their parents upon exit from care while 19% were adopted, 16% were provided with guardianship, 10% were transfered to another agency, 6% aged out, and 1% exited care for other reasons. The Chafee Foster Care Program for Successful Transition to Adulthood, including the Education and Training Voucher (ETV) Program, provides flexible funding to promote and support youth who have experienced foster care at age 14 or older in their transition to adulthood. Through the Family First Prevention Services Act (FFPSA), North Dakota has extend the maximum eligibility age and use Chafee funds to serve youth to age 23, and ETV funds to serve young people to age 26, as allowed by FFPSA.

FACT SHEET WELL-BEING SERVICES Since FFY 2018, there has been a The Division has several family preservations programs, implemented to curtail the 6% decrease in children in foster rising number of children placed in foster care including: care while there has been a 5% increase in the number of families • In-Home Case Management engaged with In-Home Case • Parent aide services Management services. • Safety/Permanency Funds • Prime Time Child Care There has been a 25% increase in • Respite Care the number of families receiving In-Home Case Management Family Centered Engagement (FCE ) - a facilitated team process - make critical since FFY 2016. decisions with families regarding the removal of children from their homes to the least restrictive and safest placements that are in the best interest of the children. FCE was Website resources for kinship implemented in a select number of counties in 2018 and implemented statewide in families are available at 2020. To date, there have been 386 FCE meetings and at the 6 month follow-up, KinshipND (https://kinshipnd. just over 71% of children remain with their parents and siblings. com/). Kinship care is the full-time care, nurturing, and protection of a child by relatives, For more information: members of their Tribe or clan, godparents, stepparents, or other adults who have a family relationship to a child. There is typically increased stability and reduced Children and Family Services Division trauma for children when placed in kinship care. Children are also able to maintain significant connections with family and cultural traditions. Lutheran Social Services 600 E. Boulevard Avenue, Dept. 325 of North Dakota and CFS administrators launched a website resource for kinship Bismarck, ND 58505-0250 families. KinshipND (https://kinshipnd.com/). Phone: (701) 328-2316 Toll Free: (800) 245-3736 In North Dakota, the number of children in foster care continues to increase. There Relay ND TTY: 711 has been a 52% increase in the number of children in foster care over the last ten Fax: (701) 328-3538 years. Of those, the percentage under the age of 5 years has steadily risen from Email: [email protected] 28% to 40% during the same timeframe. The Family First Prevention Services Act was signed into law as part of the Bipartisan Budget Act on February 9, 2018. This act reforms the federal child welfare financing streams, Title IV-E and Title IV-B of the Social Security Act, to provide services to families who are at risk of entering the child welfare system. The bill aims to prevent children from entering foster care. Provides new title IV-E funding for prevention services for candidates for foster care and their families for: o Mental Health o Substance Abuse o In-Home Parent Skill-Based Programs (i.e. parenting skills training, parent education, and individual and family counseling) 45

FACT SHEET EARLY CHILDHOOD SERVICES There are 1,184 licensed child Under N.D.C.C. § 50-11.1, the North Dakota Department of Human Services is care providers in North Dakota required to administer the licensure of Early Childhood Services (child care) and with a capacity to serve 33, to develop standards to regulate child care settings. This responsibility falls to the 394 children. Children and Family Services Division. More than 800 child care There are a number of licensing categories available to providers including: providers from across North • Licensed Family Child Care: Family providers may care for up to seven children Dakota participate in the Childcare Emergency Operating with no more than under the age of 24 months, plus two additional school-age Grant. The program distributes children. approximately $3.8 million in • Licensed Group Child Care: Group child care programs may be licensed in grant funds to participating child a home or a facility. Groups may be licensed for up to 30 children, with the care providers every month. actual license capacity determined by available space, staff to child ratios, and sometimes local ordinances. For more information: • Licensed Child Care Center: Child care centers are licensed for at least 19 children in a facility, with the actual license capacity determined by available Children and Family Services Division space, staff to child ratios, and sometimes local ordinances. • Licensed Preschools: Preschools provide educational and socialization 600 E. Boulevard Avenue, Dept. 325 experiences for children age two years to kindergarten and may operate Bismarck, ND 58505-0250 sessions for no more than three hours per day. Phone: (701) 328-2316 • Licensed School-Age Programs: School-age programs are licensed for at Toll Free: (800) 245-3736 least 19 children in a facility, with the actual license capacity determined by Relay ND TTY: 711 available space, staff to child ratios, and sometimes local ordinances. School- Fax: (701) 328-3538 age programs offer services before and after school, and sometimes on school Email: [email protected] holidays and through the summer months. • Multiple License Facility: This type of program has more than one type of license, 46 such as a center and preschool. In FY2016 there were 1,346 licensed child care providers in North Dakota with a capacity of 31,094 children. In FY 2020, there were 1,184 licensed child care providers with a capacity of 33,394 children. North Dakota is working with GL Solutions, Inc. to develop a statewide electronic child care licensing system that will bring North Dakota into compliance with federal regulations, allow the state to monitor and track the licensing process more efficiently, and provide consumer-friendly and easily accessible information.

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48 DataFigures

Figure 6: Reports of Suspected Child Abuse and Neglect, FFY 2010 - FFY 2019 16,733 18,000 1,797 FFY 2019 16,000 15,676 16,457 14,000 12,000 13,700 14,332 2,097 10,000 FFY 2018 12,392 11,442 10,771 9,540 9,840 8,000 6,000 4,000 1,517 1,688 1,760 1,911 2,064 2,000 1,134 1,295 1,402 0 FFY 2011 FFY 2012 FFY 2013 FFY 2014 FFY 2015 FFY 2016 FFY 2017 FFY 2010 Reports of Suspected Child Abuse and Neglect Child Victims of Abuse and/or Neglect 49

50 Figure 7: Type of Maltreatment, FFY 2010 - FFY 2019 Psychological Maltreatment Neglect Sexual Abuse Physical Abuse 5883 4861 5536 4514 4588 5109 4688 4641 4815 4913 3842 3031 2618 2392 2302 2315 2812 2287 2397 2553 1710 1769 1659 1640 1543 1370 1520 1580 1802 1688 241 260 283 273 250 239 202 227 292 291 FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 FFY 2015 FFY 2016 FFY 2017 FFY 2018 FFY 2019