The Nebraska State Office Building on Tuesday, Jan. 18, 2022, in Lincoln. (Rebecca S. Gratz for the Nebraska Examiner)
LINCOLN — A program meant to offer state resources to Nebraska children suspected of being abused or neglected while keeping more of them at home and out of foster care is not being used as intended, an inspector general’s report alleges.
The Office of Inspector General for Child Welfare began investigating the state’s Alternative Response (AR) program after it received nine notices between 2021 and 2024 of children having suffered serious injuries and three of them dying within months of their families being assessed through the program, which is manned by the Nebraska Department of Health and Human Services.
Dr. Alyssa Bish, director of the Nebraska Department of Health and Human Services division of children and family services. (Courtesy Office of Gov. Jim Pillen)
AR, according to the report, is recognized as a best practice in more than 20 states. It is used as a less adversarial and more collaborative method of working with children and families to assess possible cases of child endangerment while keeping more children with their families.
Though AR is meant to be used for mid- to low-risk cases, the report found nearly half of the families DHHS assessed were deemed to be high-risk or worse of future mistreatment. The OIG report notes that between 2021-2024, DHHS completed AR assessments for more than 17,000 families, and over 7,800 of them qualified as high or very high risk.
AR was implemented as a pilot program in Nebraska in 2014. It was added as a permanent program in 2020. Inspector General Jennifer Carter noted that during its pilot years, there were no reported cases of serious injuries or deaths related to AR assessments. The reports of kids getting harmed started after the program became permanent, which is part of what prompted the investigation, Carter said.
In a written response included in the report, DHHS Director of Children and Family Services Alyssa Bish argued current regulations don’t mandate how AR cases should be assigned based on risk level and noted that cases are excluded from AR when a child is determined to be unsafe.
The OIG report confirmed that DHHS has not broken the law.
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Bish explained that “safety” and “risk” are two separate measurements. Safety is an immediate assessment based on active threats of serious harm to the child, while risk is a more long-term evaluation of potential for future harm.
“It is important to clarify that the level of risk can only be evaluated after an intake is determined to be eligible for AR and the assigned Children and Family Services Specialist has made contact with the family,” Bish wrote.
Carter’s report criticized multiple deficiencies found in DHHS’ AR process, noting multiple errors found within the assessments of the nine cases the Inspector General’s Office reviewed in depth.
The report also raised concerns about DHHS’ “limited review” of each family’s history when assigning AR cases. In more than one of the nine reviewed cases, reports of suspected abuse within the family were missed, including at least one in which the OIG said there had been a report of abuse filed within the family nine months before the AR assessment.
“A family could have extensive previous intakes over many years that indicate a pattern of concerning behavior that [is] not considered if outside that six-month window,” Carter argued.
The OIG report makes several recommendations, including that DHHS improve its data tracking and find ways to encourage families to more easily engage more with state resources. Of the nine cases, a majority of families declined DHHS resources after receiving an AR assessment.
“It is impossible to say that AR services being provided would have stopped the incidents from occurring in those cases,” Carter wrote in the report. “But in AR cases, unlike court-involved cases, engaging the family during the AR assessment is the only way to provide the family with the supports they need to address concerns in the home.”
Carter praised DHHS for enhancing its data tracking system in February to include a note when families decline state services, calling it “a great step.” She suggested DHHS ought to align its data on AR with HHS data on the agency’s more common Traditional Response method to alleged abuse or neglect. The goal: to be able to compare the effectiveness of each program under certain circumstances.
Bish noted multiple updates DHHS has made to its AR system before the OIG report came out, including a new tool that reviews the frequency and quality of contact with families within the program. However, Bish noted that this tool does not evaluate families’ level of engagement with state resources for families.
“DHHS acknowledges the importance of this recommendation and is open to further exploration and development of metrics or tools that could more explicitly assess engagement outcomes,” Bish wrote.
Carter emphasized that despite her critiques, Alternative Response remains a useful tool that can recognize nuanced cases, such as families in poverty that could be mistaken as neglectful.
However, she argued that more attention should be paid to the outcomes of families assessed under AR and suggested DHHS and the Nebraska Legislature should consider whether risk level of future abuse or neglect should be a factor in assigning AR cases.
DHHS did not respond to requests for additional comment on the report.