22VAC40-705-180. Training.

B. Workers shall complete skills and policy training specific to child abuse and neglect investigations and family assessments within the first year two years of their employment.

Of concern in the above section is the elimination of the requirment that this training occur in the first year of employment.  It is important to note that CPS workers tend to have a high turn over rate in the DSS Systems.  By extending the time limit to two years it is significantly possible that the worker will never receive this training and can move onto another agency for less than two years and again not receive this training. 

This training is critical to determining the immediate and future safety and stabiliy of a child/children.  Further, without this training in the first year, the testimony of a CPS worker in a Court proceeding can be seriously called into questions by defense attorneys because of the lack of proper and complete training to appropriately investigate the case.  The child's safety and stability can be further jeopardized by inadequate and impeachabel testimony by the CPS worker.  It is not uncommon at all in adjudicatory trials that the CPS worker's trainings and certifications are placed under very significant scrutiny. 

I have grave concerns about the appropriateness of the use of the word life-threatening.  Lots of medical diagnoses are life threatening especially if left untreated.  Lots of these medical diagnoses are acute in onset and rapdily resolve with treatment e.g. ....a shattered spleen from a bike accident that requires blood transfusion and splenectomy and the child returns to school in one week with no residual illness.  This child left untreated would be dead. .....a pneumonia or urinary tract infection that can be successfully treated with antibiotics and the child returns to school in one week with no residual illness.  This child left untreated has a significant risk of becoming critically ill.  I believe that the heart of the issue lies around diagnoses that are chronic and do not always respond to treatment.  I do not think that this term life threatening is being used appropriately and will boarden the application of the bill and confuse treating physicians like me. Respectfully Robin Foster

Unless otherwise stated, I am in agreement with many of the changes made to the regulations – particularly those that:

• modernize the language regarding audio recordings to allow for the use of newer, more efficient recording devices;
• make a positive drug toxicology of the mother sufficient to indicate suspected abuse or neglect for reporting purposes; and
• shorten the time that an agency has to make an initial intake decision.   

Other positive changes incorporate into the regulation recent changes in law and most of those changes simply add the language stated in the Virginia Code which is fairly explicit. Several others make sensible changes to the way agencies do their work without negatively impacting the protection of the children.

I have concerns about the following proposed changes.

1.  One problematic change in administrative process is the change suggested to the section on “Family assessment and investigation contacts”.  A change is suggested for Section B.1.d which is as follows – “In the context of a team investigation with law-enforcement personnel, the team or team leader determines that audio taping is not appropriate.  The local Commonwealth Attorney determines that electronic recording of the victim interview during the CPS investigation is not appropriate in the context of the criminal investigation.”   Many times the Commonwealth Attorney is not involved in investigations early on when these decisions are being made and it would be better to keep this section as it was originally worded.

2.  Of huge concern are the definitions and language that have been added to help implement “Abraham’s Law,” a bill intended to address the ability of an adolescent, challenged by a terminal illness, to refuse research validated and potentially life-saving conventional medical treatment.  This is a complex piece of legislation which is very subjectively worded and creating verbiage to guide its implementation is a difficult challenge. 

A serious problem (albeit one imbedded in the Code) having potential unintended consequences is the term “life threatening condition.”  This is a label for a number of possible conditions and when one of these conditions is encountered in an Emergency Room where fast treatment is of the utmost importance, if treating physicians were required to jump through all of the hoops required in this legislation before performing a life-saving measure, the child may very well die. A better term and one that probably more closely states the original intent of the bill is “terminally ill.”

Given the fact that the law is what it is, I have the following concerns.

The bill and regulations contain a number of subjective and imprecise definitions that outline the conditions necessary for a child to be allowed to refuse conventional and potentially life-saving medical treatment.  The Code also just specifies that alternative treatments merely be considered.  It does not address whether they are used or not.

These are life or death decisions and neither the Code nor the regulations mention by whom and how these decisions will be made.  It is hoped that these critical decisions will be determined by a judge in a court of law in an expeditious manner, using a Guardian ad Litem and appropriate expert witnesses and evaluators to insure that factors addressed in the Code are met, that the best interest of the child is protected and, in particular, that

• the alternative treatment is appropriate;
• the opinion of the child is not coerced and made on the basis of factual knowledge regarding all options;  and
• the child is not cognitively impaired and is sufficiently mature to make such a life and death decision.

Although it is anticipated that all decisions in such cases would be referred to a judge for a full hearing, I would request that this be stated in the regulations to better guarantee that the best interest of the child is fully considered.  Moreover there should be a requirement that such hearings and decisions should be made in the most expeditious manner possible.

3.  There was also some concern voiced about increasing the time allowed for new worker training to two years.  It is my understanding that policy will list the specific classes required. If the Board keeps the two year window for training in the regulations, it is my hope that the Board would review the list of courses and thoughtfully identify the critical core courses that would be required for new workers to take within the first year of employment.  Child welfare work is difficult and workers who are not adequately trained cannot effectively protect children or help families. 

The addition of training requirements for supervisors is much needed.  The lack of training requirements for supervisors has impacted the quality of supervision in a number of the local agencies around the state.  It is hoped that training requirements for supervisors will be on-going and not limited to just one or two classes.

I would also like to suggest the following addition to the current regulations. Policy training should be required for all state and local Child Protective Services (CPS) hearing officers.  Without complete understanding of the CPS process and some insight into how these policies actually work, it would seem that these officers, who for the most part have not worked for or in a local agency, would be at a disadvantage when trying to make decisions that are equitable to all parties involved.