Summary Notes

Paternity Establishment Performance

Peer-to-Peer Training Conference

June 21 -- 22, 2005

Dallas, Texas

U. S. Department of Health and Human Services

Administration for Children and Families

Office of Child Support Enforcement

**Table of Contents**

[I. Meeting Summary 3](#meeting-summary)

[II. Performance Measurement 3](#performance-measurement)

[A. Group 1 - PEP Performance 3](#group-1---pep-performance)

[State of Colorado -- Bob Conklin 3](#state-of-colorado-bob-conklin)

[State of Oklahoma -- Anthony "Tony" Jackson
3](#state-of-oklahoma-anthony-tony-jackson)

[Group 1 Best Practices 3](#group-1-best-practices)

[B. Group 2 -- PEP Performance 3](#group-2-pep-performance)

[State of Oregon -- Brian Thompson 3](#state-of-oregon-brian-thompson)

[State of Texas -- Joan Hutcheson 3](#state-of-texas-joan-hutcheson)

[Group 2 Best Practices 3](#group-2-best-practices)

[C. Group 3 -- IV-D Performance 3](#group-3-iv-d-performance)

[State of North Dakota -- Paulette Oberst
3](#state-of-north-dakota-paulette-oberst)

[State of Minnesota -- Anne Lauer, Brenda St. Sauver
3](#state-of-minnesota-anne-lauer-brenda-st.-sauver)

[State of Wisconsin -- Patti Reuter 3](#state-of-wisconsin-patti-reuter)

[Group 3 Best Practices 3](#group-3-best-practices)

[D. Group 4 -- Statewide Performance 3](#group-4-statewide-performance)

[State of Virginia -- Nick Young, Connie White
3](#state-of-virginia-nick-young-connie-white)

[State of Georgia -- Cindy Moss, Robert Riddle
3](#state-of-georgia-cindy-moss-robert-riddle)

[Group 4 Best Practices 3](#group-4-best-practices)

[III. Data Reliability 3](#data-reliability)

[E. Group 1 -- Data Reliability: IV-D States
3](#group-1-data-reliability-iv-d-states)

[State of Minnesota -- Anne Lauer, Brenda St. Sauver
3](#state-of-minnesota-anne-lauer-brenda-st.-sauver-1)

[State of North Dakota -- Terry Peterson
3](#state-of-north-dakota-terry-peterson)

[State of Wisconsin -- Patti Reuter
3](#state-of-wisconsin-patti-reuter-1)

[Group 1 Best Practices 3](#group-1-best-practices-1)

[F. Group 2 -- Data Reliability: Statewide States
3](#group-2-data-reliability-statewide-states)

[State of Colorado -- Bob Conklin 3](#state-of-colorado-bob-conklin-1)

[State of Oklahoma -- Anthony "Tony" Jackson
3](#state-of-oklahoma-anthony-tony-jackson-1)

[State of Oregon -- Bill Bell 3](#state-of-oregon-bill-bell)

[State of Virginia -- Nick Young, Connie White
3](#state-of-virginia-nick-young-connie-white-1)

[G. Group 3 -- Data Reliability: States that Switched PEP's
3](#group-3-data-reliability-states-that-switched-peps)

[State of Minnesota -- Anne Lauer 3](#state-of-minnesota-anne-lauer)

[State of Georgia -- Cindy Moss 3](#state-of-georgia-cindy-moss)

[IV. Appendix A -- Questions and Answers
3](#appendix-a-questions-and-answers)

[H. Performance Measurement Question and Answers
3](#performance-measurement-question-and-answers)

[Group 1 - Colorado 3](#group-1---colorado)

[Group 1- Oklahoma 3](#group-1--oklahoma)

[Group 2 3](#group-2)

[Group 3 3](#group-3)

[Group 4 3](#group-4)

[I. Data Reliability Question and Answers
3](#data-reliability-question-and-answers)

[Group 1 3](#group-1)

[Group 2 3](#group-2-1)

[Group 3 3](#group-3-1)

[V. Appendix B -- Meeting Agenda 3](#appendix-b-meeting-agenda)

[VI. Appendix C - Attendees 3](#appendix-c---attendees)

#  Meeting Summary

The Paternity Establishment Performance (PEP) Peer Mentoring was
initiated by the Office of Child Support Enforcement, Division of
Planning, Research and Evaluation as an interactive forum for states
seeking help improving their paternity establishment performance. The
two-day meeting brought together participants from states that reported
exemplary paternity establishment performance (known as *mentor* states)
with staff from states seeking improvement (known as *student* states).

The basic format used for the event involved a series of presentations
prepared by mentor states on a specific paternity establishment related
topic. Topics addressed during the two days included: [^1]

-   PEP Performance

-   IV-D Performance

-   Statewide Performance

-   Data Reliability: IV-D States

-   Data Reliability: Statewide States

-   Data Reliability: States that Switched PEP's

At the conclusion of each presentation, or group of presentations,
student states were given the opportunity to pose questions to the
speakers. In addition, at the conclusion of each presentation, the
audience was asked to identify "best practices" that they heard the
presenters discuss that would be useful for their state to adopt.

This document summarizes each presenter's discussion and best practices
identified by the audience. Questions posed to the presenters and their
answers are found in Appendix A.

The list of attendees is found in Appendix C.

#  Performance Measurement

## Group 1 - PEP Performance

-   Colorado

-   Oklahoma

### State of Colorado -- Bob Conklin {#state-of-colorado-bob-conklin .unnumbered}

> ***Presentation Synopsis***
>
> Colorado emphasizes three important facets for a successful paternity
> establishment program: Focus, Program & Policy, and Reports.

-   Focus: PEP performance is directly related to the level of attention
    focused on the program. It is beneficial to have one program point
    of contact that focuses on goal achievement. That person should
    understand the Acknowledgement of Paternity processes (both within
    the IV-D agency and other participating agencies). Improving PEP
    performance also requires adequate resources; when acquiring
    resources be sure that decision makers understand the ripple effect
    of poor PEP performance.

-   Program & Policy: The PEP process, and the corresponding policies
    driving it, must be conducive to encouraging and quickly processing
    the Acknowledgement of Paternity form. Developing a good working
    relationship with supporting agencies such as Vital Records and
    hospitals is critical for ensuring that the overall process is
    efficient and effective.

-   Reports: Reports that provide feedback at the "service" level (i.e.
    hospitals) are necessary in order to detect and correct performance
    problems early on.

> Colorado instituted a newsletter to communicate with and educate those
> involved in the paternity acknowledgement process.

### State of Oklahoma -- Anthony "Tony" Jackson {#state-of-oklahoma-anthony-tony-jackson .unnumbered}

> ***Presentation Synopsis***
>
> In previous years paternity acknowledgement had been neglected so, to
> improve performance, Oklahoma refocused attention on the paternity
> acknowledgement program. IV-D took several steps to improve the
> process and create awareness regarding the importance of
> acknowledgements, including:

-   Developing a performance measurement-training program for all IV-D
    staff, which includes how workers can ensure they get credit for
    paternity establishment;

-   Instituting a paternity establishment newsletter;

-   Establishing good working relationships with both hospitals and
    Vital Records in order to improve the process;

-   Providing performance feedback to hospitals;

-   Frequent contact with the hospitals that have high numbers of unwed
    births.

> Oklahoma IV-D found it is less costly to establish paternity in
> hospitals rather than through a court order.
>
> Hospital relations improved after dropping the notary-based form and
> replacing it with a witness-based form.
>
> Finding that hospital staff did not have the time to attend training
> sessions, Oklahoma simplified the acknowledgement process and made
> sure that hospital staff have state office and local IV-D contact
> information.
>
> Oklahoma IV-D conducts joint training sessions with Vital Records:
> IV-D covers paternity acknowledgement and Vital Records teaches how to
> create a birth certificate.
>
> Oklahoma IV-D attempted to get legislation passed that would establish
> penalties for low performing / non-performing hospitals. It did not
> pass, but it did motivate hospital administrators to become more
> cooperative.
>
> Oklahoma has found that Tribes are very different culturally regarding
> paternity establishment (they have 77 tribes). Oklahoma has
> established a Tribal IV-D office that positively impacts the state's
> PEP.

###  {#section .unnumbered}

### Group 1 Best Practices {#group-1-best-practices .unnumbered}

-   Institute a newsletter with which to communicate news and / or
    provide performance feedback to hospitals.

-   Institute a Witness-based form rather than notary-based.

-   Create feedback reports and monitor for trends, anomalies, etc.

-   Acquire dedicated resources and conduct outreach. (Recognizes the
    fact that paternity acknowledgement depends on a lot of external
    partners which requires time and resources.)

-   Establish a Paternity Acknowledgement point person

-   Establish a website with information for hospitals and other related
    organizations.

-   Establish a functional link with Vital Records.

-   Focus on both IV-D PEP and statewide at the same time

## Group 2 -- PEP Performance

-   Oregon

-   Montana

-   Texas

### State of Oregon -- Brian Thompson {#state-of-oregon-brian-thompson .unnumbered}

***Presentation Synopsis***

Currently, Oregon is focusing attention on hospitals and the paternity
completion process. They discovered that in many cases hospital staff
are not completing the paternity acknowledgement process. Oregon IV-D
meets quarterly with Vital Records staff to discuss issues and answer
paternity related questions, and discuss ways to improve performance.
IV-D staff provide training as needed.

Oregon developed a paternity video for hospital staff to use to inform
parents of their rights. Parents can view the video and, afterward,
staff will request that they sign the acknowledgement form, which is
available in four languages. The forms contain information parents need
before they sign.

Vital Records distributes a newsletter; the current issue is focused on
paternity establishment and hospitals that do a good job establishing
paternity.

Portland is on the border with Vancouver, Washington. Oregon IV-D has
established an interstate agreement with Washington to establish
paternity in cases where the child was born in Oregon. Oregon pays the
fee to get acknowledgement recorded when established outside of Oregon.

**State of Montana -- Tina Green**

***Presentation Synopsis***

Montana is an administrative state, one in which parties have the right
to a judicial review. There are 5 regional offices, and the average
caseload ranges from 400 to 500 cases per worker. There isn't a separate
paternity unit.

Montana uses the IV-D PEP and relies on caseworkers to record paternity
data correctly. Workers check with Vital Statistics to determine if
paternity has been established for out-of-wedlock births.

Hospitals record many of Montana's paternities; they are paid based on
the information they send. In the past, IV-D provided them with training
and paternity materials but no longer does so because of budget cuts.
Currently, the hospitals are essentially self-maintaining. Training for
new workers is provided when requested.

Montana is very satisfied with the IV-D PEP, and has no plans to change.
They have passed all audits, although they did receive a marginal pass
which prompted an internal correction to improve their statistics. The
correction involved a manual examination which required them to find the
paternity information in the physical file and do a match.

Caseworkers are responsible for recording paternity data accurately.
Separate screens for each child are maintained; the screens include data
for multiple alleged fathers and for 157 data. The default indicator for
every child is "born out of wedlock" and remains coded this way until
proof of paternity and other related data are received. All workers are
provided training guides that provide detailed instructions in how to
complete the screens.

The system generates daily ticklers to remind workers that an action is
due. In addition, there is a report that workers can access that states
exactly the case status (for example, establishment), paternity status,
and if any required data (for example, social security number) is
missing. Workers generally review their cases every 90 days.

Statistical data are distributed to regional managers each month. In
addition, each month a random sample of 157 cases is audited to
determine if any deficiencies exist. IV-D also conducts an annual audit
of the 157 data.

### State of Texas -- Joan Hutcheson {#state-of-texas-joan-hutcheson .unnumbered}

***Presentation Synopsis***

Approximately 69% of acknowledgements in Texas are completed in
hospitals, so IV-D focuses their program support there. The remaining
acknowledgements are adjudicated. One of the biggest challenges for IV-D
is providing on-site support given that there are 263 hospitals spread
out over a wide geographic area.

In Texas, the Acknowledgement of Paternity (AOP) is not notarized nor
witnessed; however, identification is requested from the parties. Since
Texas is a common law state, they encourage parents to do AOP even in
those situations.

Texas law requires that all paternity acknowledgement workers be
certified. IV-D has developed a training and certification program to
ensure that the law is met, and reported that the training has helped to
improve relations with hospitals. During on-site visits with hospitals,
IV-D staff tries to determine if any changes have been made that might
impact their ability to complete the acknowledgement process. They
encourage hospitals to track and report AOPs. IV-D receives a quarterly
AOP report by hospital to track how many are being processed.

Texas instituted a parent survey that provides rights and responsibility
information to ensure that parents properly informed. Parents are each
asked to sign the survey (form) even if they also complete the AOP.
Hospitals log if parents are given the form and if it was signed. IV-D
uses this to monitor and support the acknowledgment program administered
at the hospital.

Texas has also instituted a program targeting incarcerated fathers. It
includes an 800 number for fathers to call to listen to their rights and
responsibilities and an AOP process that can be completed through the
mail.

Voluntary acknowledgement forms are included in pre-admittance packets
and also available in doctor's offices and clinics.

### Group 2 Best Practices {#group-2-best-practices .unnumbered}

-   Taking the 157 down to the caseworker level

-   Establishing a 800 number to inform parents about rights and
    responsibilities

-   The outreach program targeting incarcerated fathers

-   Accountability for hospitals that fall below 65%

-   Giving awards to well-performing hospitals.

-   Ability to have paternity acknowledged before the child is born

## Group 3 -- IV-D Performance

-   North Dakota

-   Minnesota

-   Wisconsin

### State of North Dakota -- Paulette Oberst {#state-of-north-dakota-paulette-oberst .unnumbered}

***Presentation Synopsis***

Voluntary Paternity Acknowledgement (VPA) services are offered at 22
birthing hospitals statewide as well as Regional Child Support
Enforcement Units and Vital Records. North Dakota IV-D focuses program
resources on hospitals. Data show that the predominance of
acknowledgments are completed within 3 days of birth, indicating that
hospitals do a good job of completing the process before the mother and
child are discharged. The hospital program appears to be aggressive but,
given the number of VPAs rescinded, the IV-D program is assured that the
hospitals are not overreaching.

North Dakota instituted a number of steps to ensure good performance
results. These include:

-   Establishing a contact person at each service location;

-   Working with Vital Records to develop a form with the required data
    elements and rights and responsibility information. All the written
    information the parents need to make an informed decision about
    voluntary paternity acknowledgment is on the form;

-   Requiring a witness rather than a notary;

-   Developing a brochure for parents outlining the process, benefits,
    and contact information. Brochures are distributed at service
    providers and prenatal clinics;

-   Developing an audio tape that facilitates the oral description
    requirement;

-   Developing a video training tape to use with new staff or for
    cross-training purposes;

-   Conducting an annual program assessment, which includes assessing
    records filed at Vital Records for omissions and inconsistencies and
    surveying service providers regarding their internal procedures. The
    assessment can be used to compare performance between service
    providers and from year to year.

North Dakota IV-D requires regional workers to contact Vital Records to
determine if an acknowledgement has been filed at case opening. It is
hoped that in the near future workers will have access to electronic
copies of the acknowledgement.

IV-D is working with TANF to make sure that applicants are completing a
child support information form during the front end eligibility process.
They have also developed a paternity affidavit to be completed by the
service recipient. Since it is in affidavit form, it can be used in
court if the service recipient is not available to testify. And they
have developed a worksheet for workers to use to determine jurisdiction
for tribal cases.

The IV-D information system can track court dates, hearings, and
documents and also send alerts to workers. This functionality has proven
useful for managing the paternity process.

State IV-D encourages the regional workers to conduct paternity
interviews with the service recipient if the non-custodial parent is to
be sued.

Regional workers are encouraged to promptly sanction noncooperative
service recipients and to follow up with eligibility staff to ensure
sanctions are imposed.

If needed, North Dakota can withhold medical assistance payments to
hospitals that do not provide paternity acknowledgement services. North
Dakota does not pay hospitals for securing VPAs.

Service providers are immune from liability for voluntary paternity
acknowledgment activities undertaken in good faith.

### State of Minnesota -- Anne Lauer, Brenda St. Sauver  {#state-of-minnesota-anne-lauer-brenda-st.-sauver .unnumbered}

***Presentation Synopsis***

Minnesota has responded to the paternity performance requirements
instituted several years ago by implementing a series of projects focus
specifically on the process and data requirements. Specific projects
included:

-   Creating a Paternity Acknowledgement team that involved both
    internal and external partners to assess how the state could best
    reach the performance incentive percentages issued in 2000;

-   Increasing the level of enforcement on their contract with the
    Department of Health in order to make them more accountable for some
    paternity-related deliverables;

-   Adopting the IV-D Paternity Establishment Percentage calculation
    method in 2001;

-   Using grant monies to set into place 24 hour notary service at
    hospitals in the largest county (Hennepin);

-   Developing a video for the oral requirement and translating
    paternity forms into 5 languages;

-   Developing a brochure for county staff providing information
    regarding 157 data requirements;

-   Distributing county-level performance reports monthly and providing
    online query access to detailed (caseworker level) data.

Minnesota's self-assessment unit performs PEP reviews.

Minnesota also focuses attention on improving performance of the eight
most populated counties. Activities include guided discussions with
administrators and managers to improve cooperation, identify strategies,
and establish paternity-specific initiatives. Currently they are asking
the counties to establish goals although this has been a difficult task.

### State of Wisconsin -- Patti Reuter  {#state-of-wisconsin-patti-reuter .unnumbered}

***Presentation Synopsis***

Milwaukee County ranks in the top five counties in the nation regarding
unwed births; one in three births involve unwed mothers. Wisconsin does
well in paternity establishment. Last year they reached 100%.

Paternity acknowledgement information is available in three different
languages, and a toll free number and website are available for
additional information. Parents have the ability to leave a call-back
message when using the toll free number.

Wisconsin IV-D has a state-county contract which dictates how a county
will be paid based on its performance. The State IV-D agency provides
paternity performance measurement training to all workers. Workers are
also given reports with which they can compare their performance with
that of their peers, which has helped create a competitive atmosphere
and helped improve performance. The State IV-D agency also publishes a
monthly child support letter that reports prior year performance
information so that a comparison with current year activity can be made.
A website with fact sheets and manuals related to paternity performance
is available to all counties.

Wisconsin IV-D implemented an interface with Vital Records; it provides
them information if a father has not been named within 6 months after
the birth of the child. Access to birth records is also available
online.

### Group 3 Best Practices {#group-3-best-practices .unnumbered}

-   Including paternity information / forms in prenatal package from
    doctor's office

-   Providing sample documents to anyone that requests them. (They are
    an exact replica with sample written across them because people
    giving them don't have training.) They are available in the high
    schools from guidance counselor.

-   Outreach to custodial parent six months after birth

-   Monthly 157 reporting

-   Sanctions against low performing hospitals

-   Mandatory worker training.

## Group 4 -- Statewide Performance

-   Virginia

-   Georgia

### State of Virginia -- Nick Young, Connie White {#state-of-virginia-nick-young-connie-white .unnumbered}

***Presentation Synopsis***

Virginia uses the IV-D percentage calculation method for measuring
worker performance, and the Statewide percentage method for Federal
reporting; they have found that the Statewide method gives them a higher
percentage and the data is more reliable.

It took some time, but Virginia IV-D established a good working
relationship with Vital Records. They have been able to educate Vital
Records about the importance of the paternity acknowledgement process
and data. All paternity acknowledgements are filed with Vital Records;
the agency currently maintains two databases with paternity data.

Virginia successfully privatized the in-hospital paternity
acknowledgement process primarily because IV-D does not have the
staffing resources to manage it. The choice to privatize, although not
easy, has been a good one as performance has improved. They use Federal
funds to off-set the cost. Virginia IV-D has created a competitive
atmosphere among hospitals. It gives out awards to top performing
institutions, but it also spends time with each institution to encourage
it and reinforce the importance of paternity acknowledgement.

Virginia staff rely on performance reports to monitor progress and
detect potential problems. They receive a backlog report from Vital
Records and if significantly behind, IV-D will find the resources needed
to reduce it. They also match the Vital Records paternity data with
their own paternity data to determine if there are inconsistencies or
errors.

### State of Georgia -- Cindy Moss, Robert Riddle  {#state-of-georgia-cindy-moss-robert-riddle .unnumbered}

***Presentation Synopsis***

In Georgia, paternities are established in hospitals or through the
courts. Paternities established in hospitals are filed with Vital
Records and the data stored in their database. Paternities established
through the judicial process are recorded separately by IV-D. Georgia
IV-D stresses the importance of a good working relationship with Vital
Records in order to meet the performance goals. They have taken several
steps to ensure that, including:

-   Establishing a single point of contact for Vital Records to
    communicate with IV-D;

-   Using a vendor to ensure that hospitals are in compliance and report
    data to Vital Records in a timely manner;

-   Creating a reliable interface for data sharing;

-   Paying Vital Records to enter paternity data;

-   Matching Vital Records data with the IV-D system data.

Georgia also places emphasis on hospital outreach. It identifies
under-performing institutions and works to help them improve their
performance. Staff have also increased their program marketing in an
effort to improve paternity awareness.

The Georgia legislature passed a law that allows parents to acknowledge
all of their children when there is a new birth. The paternity
acknowledgement can cover all of the children, not just the newborn.

### Group 4 Best Practices {#group-4-best-practices .unnumbered}

-   Using contractors to manage the in-hospital paternity
    acknowledgement process.

-   Being able to establish paternity for all children in a family when
    paternity is established for a newborn.

-   Being able to count paternities for children born in other states

-   Paying hospitals for paternity acknowledgement

#  Data Reliability

## Group 1 -- Data Reliability: IV-D States

-   Minnesota

-   North Dakota

-   Wisconsin

### State of Minnesota -- Anne Lauer, Brenda St. Sauver  {#state-of-minnesota-anne-lauer-brenda-st.-sauver-1 .unnumbered}

***Presentation Synopsis***

Minnesota's approach to managing data reliability involves four areas:

-   **Information Systems -** the basis of data reliability. A state
    must have accurate data and be able to create an auditable 157. In
    order to maintain a good system, Minnesota suggests limiting the
    number of programmers that are responsible for paternity-related
    functional changes, establishing a thorough testing model that
    ensures the system specifications meet policy requirements, and
    involving an auditor in the planning process to ensure that system
    changes meet audit standards.

-   **Staff --** Data entry errors are a significant contributor to poor
    data reliability. Train staff about the 157 data requirements and
    the ramifications of poor data entry. Make sure that the screen
    flows facilitate good data entry. Use "clean up" reports to help
    staff find and correct errors.

-   **Management Awareness** - At the state level all managers and
    supervisors know why it is important and how it ties to performance
    and incentive funding. We have 87 counties, and we sit down with the
    managers and staff to explain the performance measures. We tell them
    how they are doing, make suggestions and share best practices.

-   **Ongoing Evaluation -** Even if you passed a data reliability audit
    you should continue to examine the errors and assess if changes are
    needed. Worker data entry errors should be discussed by county; use
    it as an opportunity for additional training. Work with your
    auditor.

### State of North Dakota -- Terry Peterson  {#state-of-north-dakota-terry-peterson .unnumbered}

***Presentation Synopsis***

In past years, North Dakota needed to improve its performance and ensure
and enhance its continued data reliability. Staff believed they were
performing better than what their numbers showed. They approached the
challenge by examining all aspects of their data collection process.
They stress the importance of looking at the process from all
perspectives; they made the assumption that nothing was working as well
as it could. They made the commitment to act on their findings by
correcting existing problems and doing what was necessary to reduce the
potential for errors prospectively.

Their internal review resulted in some important findings and follow-up
actions including:

-   Confirmation that their actual paternity performance was being
    under-reported;

-   Flowcharting the Lines 5 and 6 OCSE-157 process (steps and data).
    Not only did this help to identify issues regarding the process, but
    it was also extremely well received by staff;

-   That staff training is critical and a continuous process. It is
    important to provide managers with materials that will help them
    educate their staff about performance and data requirements;

-   That staff should have access to some sort of desk reference or
    manual that clearly outlines data requirements; reference material
    should be specific, not ambiguous;

-   To test staff after delivering a training to assess how well they
    understand the information just received is crucial to measuring
    effectiveness of training;

-   To make sure that system Help Desk staff receive the same training
    as front-line workers and that they thoroughly understand the
    requirements;

-   That system programmers and TANF and Medicaid eligibility workers be
    trained relative to their roles in the process;

-   Adding system edits, warnings, and on-line screen information when
    possible;

-   Verifying that system codes were accurate and that workers
    understood when to use them;

-   Differences in local procedures between processing brand new cases
    and processing reopening cases sometimes allowed errors of the past
    to continue undetected.

In terms of working with staff at the local offices, North Dakota
recommends:

-   Creating a cooperative relationship with staff so that they will
    feel free to share their knowledge and ideas rather than keeping
    quiet about issues that could be affecting performance;

-   Establishing a point of contact with each of your regional offices.
    Case specific problems should filter through that one person.
    Sometimes local managers are able to identify commonalities that can
    lead to correction of local procedures that contribute to errors.
    Identifying a single point of contact at each regional office also
    raises the level of awareness about the ongoing work that needs to
    be done at each office to ensure statewide reliability of data;

-   Sharing summaries of problems occurring in a local office with all
    offices;

-   Studying DRA results and providing local offices with a summary of
    "lessons learned" from the perspective of how can a problem be
    avoided in the future;

-   Providing workers feedback through performance reports and error
    reports. Make sure that they follow up.

North Dakota suggests having a good understanding of the Vital Records
processes and training-related issues that may potentially impact the
paternity acknowledgement process, and continually examining the process
and look for issues, anomalies and way to improve it.

### State of Wisconsin -- Patti Reuter  {#state-of-wisconsin-patti-reuter-1 .unnumbered}

***Presentation Synopsis***

In the past, Wisconsin struggled to pass the data reliability audit.
Some of the steps it has taken to improve performance include:

-   Sharing the results of the data reliability audit with the counties
    so they can see what types of errors are occurring;

-   Identifying significant problem areas, creating reports, and
    reporting errors out by county and by worker;

-   Identifying reporting errors related to inadequate system
    functionality, and following up with corrective action.

Wisconsin includes people knowledgeable about the OCSE 157 in any system
change that is made, to determine if the change will impact the 157 data
collection process. Once the system change has been implemented, they
will run a 157 report to determine if there are any unforeseen errors.

Wisconsin IV-D conducts a director's dialogue and includes a discussion
that reviews the previous year's data reliability audit and discussion
clean-up and how data reliability can be improved.

Wisconsin provides auditors with query access to the system. They also
provide a "Data Reliability Audit Desk Aid" which provides a quick way
of accessing the system screens and guidance regarding where data are
located. This facilitates the auditors' review process. IV-D also makes
staff (both program and system programmers) available to the auditors to
respond to questions. In addition, there is online ability for state
staff to print birth records if needed for auditors.

### Group 1 Best Practices {#group-1-best-practices-1 .unnumbered}

-   Looking at closed cases

-   Training TANF and Medicaid workers

-   Running the 157 after a system change

-   Training staff on the 157 report

-   Flow charting the 157 process and sharing with staff

-   Automatically interfacing with Vital Records when paternity is
    established

-   Providing Desk References for auditors

-   Requiring up-front cooperation with child support as an eligibility
    criterion for TANF

## Group 2 -- Data Reliability: Statewide States

-   Colorado

-   Oklahoma

-   Oregon

-   Virginia

### State of Colorado -- Bob Conklin {#state-of-colorado-bob-conklin-1 .unnumbered}

***Presentation Synopsis***

Colorado believes that ensuring data reliability starts by knowing your
data sources. If the data you use is derived through external agencies,
it is necessary to understand their processes. It is also important to
understand what steps they (external agencies) take to ensure that the
data is reliable. For example, do they audit their processes?

It is also important to create a mechanism to catch errors. Self-audits
are useful for detecting problems before the (Federal) auditors do their
job. Even if Colorado passes an audit, they will use the report to
identify potential problems. Also be aware of any system changes or
conversions because these activities can significantly impact your data
reliability.

Colorado is satisfied using Vital Records data for their performance
measure. The agency has established good audit processes and has won
awards for their data reliability. Having a good working relationship
with Vital Records is also important, particularly if you want to
understand their processes.

Colorado prefers using the Statewide measurement.

###  {#section-1 .unnumbered}

### State of Oklahoma -- Anthony "Tony" Jackson {#state-of-oklahoma-anthony-tony-jackson-1 .unnumbered}

***Presentation Synopsis***

Oklahoma feels that, even though their paternity data are coming from an
outside source (Vital Records), IV-D still owns and is responsible for
the paternity data process. They also believe that building and
maintaining a good working relationship with Vital Records is central to
ensuring data reliability. However, having solid systems and processes
in place are what will ensure long-term reliability. Therefore, it is
important that each understands what the other is doing and how actions
on one part might affect the other. For example, it is a good idea for
Vital Records to understand how paternity data are being audited.
Likewise, it is important for IV-D to understand how Vital Records
determines whether data will be accepted or rejected. Other examples
exist.

Oklahoma IV-D provides training to everyone in Child Support (workers to
the Director), on the 157 process and data requirements, as well as the
performance measures on which they are audited. This has benefited data
reliability.

Oklahoma recommends taking steps to facilitate the auditor's job.
Prepare what they need to review before they arrive. Make staff
available to answer questions. Facilitate their contact with Vital
Records and other agencies. Bottom line: do not obstruct but rather be
helpful.

### State of Oregon -- Bill Bell {#state-of-oregon-bill-bell .unnumbered}

***Presentation Synopsis***

Oregon works with Vital Records data to report their paternity
performance. They have worked with Vital Records to get the data they
need to monitor the process for problems. At first, detailed data were
not readily available, but recently IV-D has taken more control by
requesting specific data from the agency.

Oregon will compare current year numbers with past year numbers in order
to identify anomalies. They also prepare a report that is similar to the
one that the auditors are given in order to assess data reliability.

Oregon tries to maintain a good working relationship with the audit
team, and facilitates their process as much as possible. For example,
they provide them assistance when the auditors need to access the
information system.

### State of Virginia -- Nick Young, Connie White {#state-of-virginia-nick-young-connie-white-1 .unnumbered}

***Presentation Synopsis***

Virginia believes that it is important to build systems that help staff
to successfully complete their job and minimize errors. They also
believe that it is good practice to assist the auditors in any way
possible -- IV-D's job is to make it easier for other people to do their
jobs.

Virginia believes that performance and data reliability go hand in hand,
even though the discussion during the past two days has separated the
two.

Virginia recommends developing very clear policies and procedures
regarding paternity establishment if reliable data are desired. Too much
discretion left up to the worker will result in errors.

Virginia uses its in-hospital paternity vendor to conduct Quality
Assurance testing on both the in-hospital and IV-D acknowledgments of
paternity. It is a good way to establish standards, do follow-up with
these institutions and IVD staff, and identify and plan for problems
that may spring up in the future.

Virginia is currently working on two significant data issues:

-   Courts sending records directly to Vital Records. IV-D does not have
    a good mechanism to feed back errors to the courts. It's important
    to give the courts feedback so that corrections can be made.

-   Access to data in the Vital Records database. Previously, IV-D had
    online access. It was important for our child support system to
    match the child's name and date of birth. If they did not match, it
    created an issue. About two months ago vital records shut off
    on-line access to their birth records. Although more time-consuming,
    Virginia is working out a procedure to get the information from
    Vital Records.

## Group 3 -- Data Reliability: States that Switched PEP's

-   Minnesota

-   Georgia

### State of Minnesota -- Anne Lauer {#state-of-minnesota-anne-lauer .unnumbered}

***Presentation Synopsis***

Minnesota feels that the switch was not significantly difficult.
Probably the biggest challenge was conducting an audit of previous
year's data under the guidelines of the new calculation method.

IV-D found it difficult when new auditors (caused by a staffing change)
arrived in 2004 and focused on different areas than the previous
auditors. If that happens, it is a good idea to have an initial meeting
to discuss process, standards, etc.

### State of Georgia -- Cindy Moss {#state-of-georgia-cindy-moss .unnumbered}

***Presentation Synopsis***

Georgia believes that the key to their success is a data reliability
plan developed to correct errors in the system and the paternity
acknowledgement process. Every paternity was reviewed, and clear
definitions created so that there was minimal discretion at the worker
level. Coding practices were reviewed and corrected as needed.

Georgia also feels that increasing system functionality leads to
improved data reliability. For example, system edits that compares data
to determine if there are inconsistencies.

There was a large number of records that required updates; caseworker
responsible for establishing orders were requested to review and make
corrections. They learned during the reviews.

Georgia used training of both new workers and veterans to educate about
the paternity fields in the information system. The training stresses
the importance of accurate data entry.

Georgia recommends that states completely understand the data that is
being reported to OCSE prior to sending it.

#  Appendix A -- Questions and Answers

## Performance Measurement Question and Answers

### Group 1 - Colorado {#group-1---colorado .unnumbered}

> Q -- You talked about the hospital you had a problem with. Have you
> had to go up the admin line?
>
> A -- Yes, we still have a couple of problem hospitals we have been
> working on for years. We have worked up the food chain. If they aren't
> going to listen to us about getting rid of someone because of
> statistics, but if we pitch it with a customer service spin, that
> their customers want to acknowledge paternity, it is hit or miss
> whether going up the chain is effective.
>
> Q -- Did you think of paying the hospital the incentives?
>
> A -- We did at first. Our decision was, for small hospitals, it is not
> that big a pool of money. Big hospitals with thousands of births, the
> accounting nightmare is something they don't want to bother with. We
> came up with the idea of buying car seats and that didn't work. We
> didn't think it was a good idea to pay them. We did explore that.
>
> Q -- We have the same problem with notary in the Virgin Islands. They
> look at child support as a cash cow. It is interesting that you didn't
> have a notary. Were there higher incidents of fraud?
>
> A -- There is no hard evidence but I don't think so. Notarization
> wouldn't stop fraud. We want the real dad not just some guy. We
> experimented and a child support worker went to these hospitals and he
> was told the worker pitched the form to a young girl. The girl was
> reluctant. The boy with her offered to sign the form but he didn't
> understand the implications and he was not the father.
>
> Q -- How often do you train hospitals and where are you getting
> numbers for reports?
>
> A -- Vital Records quarterly for hospital performance and an annual
> report, enumerator and denominator for vital records.
>
> A -- Our goal is to train hospitals every year and low performing
> hospitals additionally if we can get in.
>
> Q -- Talk more about the newsletter details.
>
> A -- We wanted to keep paternity in people's minds. Nurses will look
> at it and throw it away but if they read a line or two we keep
> paternity in their minds. We have a paternity hot line with a phone
> number to anyone. It rings on my line and two of my staff's. They
> answer any questions people have. We have Q&A about genetic testing or
> how to get the birth certificate, how to change the child's name. It
> is generally low key information. We publish an article every quarter.
> That is really easy. We find good articles and get permission to
> reprint them. We have contact information for me and my staff, and key
> contacts for Vital Records. They can get something out of it. We
> maintain the same look throughout our newsletters.
>
> Q -- How much staff time for putting together the newsletter and
> feedback?
>
> A -- Less than two days of work and people like the Q&A most, genetic.
> Hospitals performing best liked it but those not performing well
> didn't. Hospitals like having someone they can call and dump a patient
> on or get answers themselves. Where do we file child support?
>
> Q -- Can you send us a copy of the newsletter?
>
> A -- Yes. If I can send it electronically I will. If not I'll send
> everyone a copy.
>
> Q -- Did you pay hospitals in the beginning?
>
> A -- No. We went to hospitals and said this is an option. We went to
> Denver General and they said it was a bureaucratic nightmare and it
> wasn't worth their while.
>
> Q -- Do you have an interagency agreement with Vital Records? How do
> you improve that?
>
> A -- We worked an interoffice agreement. We got a change in personnel
> that really helped. Initially there was such friction but it takes a
> long time and throwing a little cash at it. It is federally acceptable
> to do that. If you get a lot of players out of it and develop a
> personal relationship it is really important. If you have six people
> calling you, the counties do not call him, they call me and I call
> him. It is super hieratical and they all funnel through me, or at a
> lower level through some of my staff members. You have to keep
> plugging away. Talk about any success and share the vision with them.
>
> Q -- Is the audience for the newsletter just hospital staff or do
> parents get it?
>
> A -- Individuals don't get it but professionals get it. The IV-D
> administrators get it too. Paternity point people in each county,
> registrar with Vital Records, they get genetic testing and those
> people don't know anything, what it costs or how you go about it. Our
> mailing list is pretty extensive, over 900 people. Keeping up with the
> mailing list is a lot of work. Nurses change hospitals along with
> medical records staff. It is a lot of work but it is worth it.
>
> Q- Do you have scheduled meetings with Vital Records staff?
>
> A -- It is pretty worked out at this point, so just as needed but
> issues always come up. It takes quite a while and a lot of work. It
> takes team building. I hate to sound like I'm bragging but I'm going
> to. It's a tribute to Ron. Our Vital Records is building a new system.
> They invited us into the build stage and asked what we needed. We are
> going to be getting more information than ever before and all it took
> was asking. There was no bill attached to it. We have read only access
> to their screens now. We've talked about having an automatic download
> but that is not in the works now. We need other things but they are
> ready to do it. We don't have regular meetings but we can call each
> other at any time. They have problems with our offices too.
>
> Q -- Do you have a problem with folks saying they are married and they
> are not?
>
> A -- Were you in my office last week? That is the crux of the problem.
> Colorado recognized common law marriages. If they say they are married
> then Dad's name goes on the birth certificate. Legally it is a
> quagmire. With a ceremony there is an underlying documentation. You
> could dig up leases but what we try to preach to our people is that it
> takes a judge to say if you are common law married. I jokingly tell
> our people if mom and dad say they are married buy them a cake and
> throw some rice because now they are.
>
> Q -- Is that too involved for a newsletter?
>
> A -- Yes. We conduct trainings and Vital Records provides semiannual
> training where we get a time slot to address issues of importance to
> us.

### Group 1- Oklahoma {#group-1--oklahoma .unnumbered}

> Q -- When you talk about doing away with the notary, did you leave the
> boxes there?
>
> A -- Originally we left the box but added witness. We are in the
> process of changing our form again and it will still be witnessed.
> Local attorneys want to add something to prevent rescissions. The
> witness says the two people are who they say they are.
>
> Q -- Did you consider incentives for the hospitals?
>
> A -- We have never paid incentives. When our budget was being
> undercut, no serious discussion was made to that end
>
> Q -- Paternity acknowledgement counts the dramatic increase -- going
> from lip service to full service?
>
> A -- Outreach and a change in notary.
>
> Q -- Do health statistics and Vital Records recognize tribal
> paternity?
>
> A -- If it is on our form. There is not a separate form for each tribe
> in Oklahoma.
>
> Q -- Is it a separate statutory provision?
>
> A -- It is not statutory. Tribal paternity establishment is less than
> 5%. They go through their own paternity. There is little incentive for
> them to use ours.
>
> Q -- \... is it a unit they contact?
>
> A -- Rural hospitals want to talk to someone in their neighborhood and
> not in the big city. The outreach coordinator takes the local child
> support person goes to the local hospital to do training. Contact
> information lists all local contacts for paternity and child support.
>
> Q -- What kind of staffing have you devoted to paternity outreach?
> training?
>
> A -- We have one person who was formerly a data entry person. She was
> too bubbly and had a background in hospital administration so we
> reassigned her. She always takes a child support person with her, but
> she does the training.
>
> Q -- Do you have a website?
>
> A -- Yes, but it is really simple. We also just got funded to do the
> interactive training for the hospitals on our website. The Oklahoma
> Hospital Association does a lot of training on line but we could not
> coordinate training with them so we will do our own.

### Group 2 {#group-2 .unnumbered}

Q -- For Texas, one page says it can be signed before birth of baby.
What date do you put?

A -- It is not filed until the birth. Attorneys are using it in divorce
as unborn child. We are a military state and Fort Hood has sent more to
Iraq than any other state. It is signed before they go and held and can
be filed with the Bureau of Vital Statistics.

Q -- For Montana, you said you are a IV-D PEP state. How do you get
105%. For 2004 it is listed as 105%. How did you get to that?

A -- All of our years have been over.

A -- (Joyce Pitts) It is possible to get over 100%. It is possible to
add children born in previous years. Also, the numerator can include
cases that are not included in the denominator such as paternities for
closed cases.

Q -- Are you using that option to include cases closed in that year?

A -- Yes.

Q -- For Oregon, have you thought about removing the fee through
legislation? In Florida there is no fee to include the parents name for
processing. There is a fee for parents, you are saying there is a fee
for -

A -- They have a fee and I don't know if they have looked into doing
that.

Q -- Why was there such a significant drop from 90% to 84% for 2004?

A -- It had to do with the backlog. They weren't keeping up. We didn't
catch it until it was too late. The main thing was that the paternities
weren't being recording at vital statistic.

Comment from Texas -- We often get statistics that say it is at 60% but
the hospital log said they are up to 70% and that is because AOPs aren't
processed. The surveys stay at the hospital and we see them when we
monitor them. We don't pay hospitals.

Q. How did they react to getting a lot more paperwork?

A -- We tell them it is for their own good. (Laughter) They were getting
parents saying they didn't know what they were signing. The parent's
survey takes the hospital off the hook. We gathered the parent surveys
and brought them to the judge and the judge said they were doing their
job.

Q - We talked about getting information from vital statistics. We only
get it on a calendar year bases. How are you getting it?

A. -- Oregon is quarterly and is looking at more often. Texas gets them
from VOS (VDS?) weekly.

Q -- What about time lags?

A --Texas has a big number crunching division. We have had to change our
criteria. We look at date of child's birth within the Federal fiscal
year (FFY) and any other AOP's we get we don't count on the 157.

Q -- Our vital statistics would not feel comfortable that they would
give us a good count number when we are ready to report.

A. They used to be two or three months behind and we weren't counting
them until November.

Q -- We have an issue because our vital statistics got bitten at one
time. I am amazed they don't have to report on fiscal year. We struggle
because they do it on calendar year.

Q -- Texas certification process?

A -- Anyone that does AOP's has to be certified. We try to train them
all in seminars. We trained 2,000 people and there is turn over. We have
to go to the hospital to make sure someone is certified. We conduct it
with Vital Statistics; it is a four hour training.

Q -- What is your experience with rescission or challenges in Texas?

A -- I don't do that end of it. I don't think there are that many
because it is an expensive ordeal.

A -- Oregon has a one-year time frame. I am not sure of the time frame
for doing it through an attorney.

A -- Texas has a four-year challenge. Minors have four years after
reaching adulthood. Teens can do AOP's without their parent's consent in
Texas.

A -- Montana is an administrative state and they have to proceed with
challenges after... in court.

Q -- What kind of sample size do you do and what staff, PEP?

A -- One staff person looks at it over the period of a week as she has
time.

Q -- Elaborate on genetic testing at the hospital.

A -- You should not do an AOP before you have genetic testing. They are
told to contact an accredited site. Hospitals have pamphlets. Some
people sign an AOP even though they want testing.

### Group 3 {#group-3 .unnumbered}

Q -- For Wisconsin, are your web-based reports available to other
states?

A -- They are internal to our state only. Some web-based are open to
public.

Q -- Are you using 157 data for rewards?

A -- We use 157 data for funding allocations.

Q -- Comments on arrangement with Vital Statistics?

A - Wisconsin has the father for every child law, HS 81. What happens is
that within six months after birth, Vital Records sends us an automated
referral. We send information to the mother and offer our services and
send a IV-D application. We send a second response and if we get no
response, we drop it.

Q. - On allocation rates, do you have a base amount that the counties
get?

A. - Yes. We have a base amount. Counties range from 600 cases to
600,000 cases. We have a base that anything over that is based on the
performance. On top of that our legislature has provided one-time
additional funding for counties below the measure. They may start a
special project. We have an arrears collection project in Milwaukee now
where workers are trying to increase their arrears collection rates.

Q -- North Dakota, are you having problems with military bases accepting
an AOP rather than adjudicated?

A -- Not to my knowledge.

A -- The California military has been cooperative with getting forms to
their members.

Q -- North Dakota, you talked about multiple alleged fathers. Do you
bring everyone in at once?

A -- We join all the alleged fathers in the paternity action at once.
This is based on state law that says the parties to a paternity action
are the child, mother, each presumed father, and each alleged father. We
would pursue genetic testing and anyone excluded by the testing would be
dismissed.

Q -- We are going the opposite direction and we ask for the mother to
give us the best choice. Pursuing one at a time is killing us.

A -- We work cases with multiple alleged fathers at the same time and we
don't want an eligibility worker to determine which alleged father to
refer to us.

Q -- We are developing a system driven algorithm.

A -- How do you make the decision which alleged father to refer?

Q -- We are having a wonderful time trying to figure that out.

Q -- Does Paulette mean the self assessment audit?

A -- We do a self assessment each year but we also do an assessment of
the state's voluntary paternity acknowledgment program.

Q -- North Dakota and Minnesota, regarding audio tapes, are the
hospitals using them?

A -- North Dakota said about 50%. It varies through the year.

A -- Minnesota doesn't have data reported at this time due to contract
changes.

Q -- Minnesota, on the changes you made with Vital Records to make them
more accountable, can you tell us more about that, the language?

A -- Part was opening the dialogue. We are in a better place but I don't
know why. People are more amiable about the language. There has been
give and take. We are still going back. Instead of stringent
deliverables, we have a modifiable working plan built into the contract.
If a situation arises where it will cost more to implement we can go
back into it and modify. We also can get information by hospital and
there are audit requirements for access to Department of Health records.

Q -- North Dakota, you mentioned conception on or off the reservation,
what does that provide you?

A -- Case law in North Dakota has focused on the place of conception of
a Native American child. That is one factor in the case. Is this a
tribal case or a state court case? Place of conception can tip the
balance to tribal if it happened on the reservation but it's just part
of it.

Q -- Everyone has online or interface with Vital Statistics. Do they
charge you?

A -- No cost for a certified copy.

A -- Minnesota is charged.

Q -- North Dakota, when the tribe establishes paternity, is there a
mechanism, do they add the name to Vital Records?

A -- There may be but I am not sure.

Q -- All IV-D workers receive measurement training?

A -- The training was at request of county child support agencies. When
we went to performance based funding no one understood how we got the
numbers. We developed curriculum. We have a training unit that is bigger
than most other state's units. We have five dedicated trainers. They
write the training and we make sure it is accurate to the curriculum. It
shows how the data is measured and the screens it comes from. If you had
a child with an N or a W, meaning paternity was established, it is
counted on various lines. It pulls the data and highlights where it is
on the screens. Email me if you want the information. We have over 1,000
workers in the counties. Most workers were required to attend. It is a
one-time training and we may provide it yearly for new workers. New
workers not understanding the ramifications is always a problem.

Q -- For paternity, you said the performance levels were down to the
worker level. How do they get those cases?

A -- Some would, some wouldn't. Our counties determine whether they want
to have units. Most counties do their case load by NCP first name.
Milwaukee has a paternity unit. The same methodology is used to
determine for each worker no matter the number in their caseload. I will
send information to anyone interested.

### Group 4 {#group-4 .unnumbered}

Q -- To Virginia, What are your experiences with PSI? We have thought
about doing that but are not ready to go there for various reasons. Once
the PSI contract is done it is panic mode. We don't want to have some
one until the end of time (contract). What is your gut feeling, not just
on PSI, but on having a private company handle paternity?

A -- We didn't say which company we contracted with. We didn't want to
steer to them. They had to compete. We contract for multiple years so we
don't have to go through the RFP process every year. Planning for the
end of a contract and the transition to a new vendor should be part of
any RFP. The numbers speak for themselves and the 12% is largely due to
them but not solely. They have brought consistency. New Jersey was
hitting at 70 to 80%. I listened to their person and it took a year to
convince the staff that I was not giving away their jobs. PSI runs two
full service offices out of our state run offices. PSI has done well for
us.

A - Georgia does 35,000 paternity acknowledgements a year. Many of the
children established in Georgia have moved from other states. We don't
foresee that problem in the future. We have multiple people to do the
marketing and the price for going through the vendor is cheaper.

Q -- We have been talking about the enumerator, paternities established.
In Florida out of wedlock has increased. One child is born out of
wedlock in the state every six minutes. We have seen the age of the
mother increase as well. Is anyone aware of any effort in social service
agencies that they are actively working to reduce births out of wedlock.
You get more paternities but that doesn't improve your stats.

A - We have a healthy marriage initiative in Georgia to take care of
that. (Laughter)

A - I do a lot of public speaking about what fuels the case load and it
is out of wedlock births. Do you want to be known as the person that
creates a vaccine or the person who builds crutches? Japan does not have
a child support system because it is so repugnant not to take care of
your child. It is a cultural phenomenon that they are responsible for
their child. People talk about how to do it faster and better but we
need to work on fixing the problem. Leon said child support was supposed
to last for three years but we can work until we are 150 and this thing
is getting bigger.

A -- We have a lot of people who move to Georgia, perhaps with the
military.

Q -- What services does the vendor provide, are they doing outreach?

A - The entire hospital program, they pay the hospital, we pay \$20 to
the hospital and they track that. They image the acknowledgements from
the hospitals as well as the IV-D. That database if available to all our
child support workers. They do QA on our IV-D acknowledgements before
they go to Vital Records. If they find errors they send them back for
update to the birth record.

Q - Are they stationed at hospitals?

A- No it is not the vendor. They depend on hospital staff.

Q -- Has anyone attempted to incorporate the acknowledgement with the
family care plan in terms of helping to identify the legal
responsibility of the soldier?

A - Soldiers are required to have a dependent care plan regarding who is
going to take care of this child, normally it's female soldier but it
can be men. They hold your feet to the fire to make sure the soldier is
not disadvantaged. It is an interesting question and I will take that
back. Initially it may be perceived as another way to get paternity.

Comment - We can package it as a service.

A -- We had a problem where a female soldier based in Germany was killed
in Iraq and we had to determine who was to take care of the minor child.
We should have solved that problem a long time ago and I will take that
back.

## Data Reliability Question and Answers

### Group 1 {#group-1 .unnumbered}

Q -- For Minnesota, how many staff do you have doing review, how long,
outcome?

A -- If it is a performance visit, the visit is typically an hour and a
half. We are in transition. Originally I had six staff but now I have
two. They assist counties with performance. We split training. Training
gets done in the training unit. They help with performance, reviews and
help county work plans. We have self assessment reviews. We take a
quarter of the counties each year and have separate reviewers conduct
the review.

Q -- IV-D exceeding 100%, how, who do I contact to find out what you are
doing?

A -- North Dakota: It is possible. You are comparing two different
years. You are using different years so you are always establishing
paternity. When you compare the two and your data is reliable, it
actually is attainable.

Student State Comment -- we have done a lot of data clean up, closing
cases, etc. We thought we did a good job and went up 10%. We are still
at 70%. What can we do to get to that level?

A -- North Dakota: I would compare the two lines (born out of wedlock
and paternity establishment) and take a hard look at the issues and why
you aren't attaining your goal.

Student State Comment -- Not being able to locate the NCP, he is
identified and he's not on the birth certificate. Until we find him we
can't serve him. We have a lot of guys in locate. Have you overcome
that?

A -- North Dakota: If that is your issue, you have to beef up your
locate efforts. Ask yourself if every piece of known information about
that NCP is on your system. If the SSN is unknown, look at the NCP birth
certificate so you can find the name of his parents and place of birth
which might enable you to access ESKARI. Send the custodial parents
questionnaires and interview them if need be. If they aren't
cooperative, use the non-cooperation penalty. It is simply a lot of hard
work.

Another point to consider is including closed cases on line 6. That has
increased our number.

Comment -- We have a locate problem. When budget cuts hit we lost some
of our locate tools. By pushing the paternity at the hospital that is
the opportunity there. Don't wait. It is so much cheaper to do it there.
Our court order paternity rate is low. Locate is low and we are seeing
other performance measures with that.

Comment - New Mexico has asked people to look through regional cases and
aggressively look at putting them in closure mode. Has your programmer
run a list of cases with the same last name? There is probably a list of
kids where paternity hasn't been established. If you have an order and a
wage withholding on him you know where he is. Get him to sign an
acknowledgement. If he won't, drag him into court. Aggressive case
closure has really helped up.

Q - Florida -- Since you report as IV-D, when CSE establishes paternity
and you properly code your system, what responsibility does your staff
have to make sure that paternity is recorded at Vital Records? It is not
really part of the training you have included. What is the follow up
step?

A - Wisconsin has an interface with Vital Records and it updates the
birth record with the father there. If there is a problem with the
system it goes to an error report.

A - Minnesota does not have an interface so it wouldn't get updated.
That came up in our audit this year. A new auditor had previously done
statewide PEP audits and we are a IV-D state. We had to go through
hoops. The IV-D is more accurate than Department of Health.

Comment -- North Dakota has zero interest in changing to statewide PEP.
We are doing well staying with IV-D PEP. Paulette stated the regional
IV-D attorney is giving a copy of the judgment to the custodial parent
and telling the custodial parent to take it Vital Records to amend the
birth certificate. Vital Records will charge if the child was born more
than one year before so that is not being done very often. We have
legislation that just passed that paternity judgments are filed with
Vital Records. Clerks aren't going to be happy about it. Court
adjudication needs to be reflected at Vital Records.

Comment - Florida has been trying to get Vital Records to do that. We
have families that have moved to Florida. They may not remember signing
a voluntary at the office. We request from Vital Records to see if
paternity is an issue. If your records don't show paternity was
established, that causes work for us. We have a statewide PEP and it
hurts our measure. Another state looking at that will not have
information they need and it is a national problem to get the records
updated properly.

Q - What do you do when you don't know the child's background? You may
not know paternity but you have an order for support. The issues of
paternity won't matter if the grandparents have the child and the mother
is paying child support.

A - We will address the paternity issue in the case against data.

A -- Wisconsin would never get a court order against a father who had
not legally been determined to be the father.

Comment -- IV-D and foster care made a throbbing in my head. We are in
the bubble right now. We don't always know establishment of paternity if
it is not related to child support.

Comment -- We have a similar situation but it occurs more with domestic
violence. There is no specific naming of the children and we don't know
the true relationship with all the partners. Interim support does not
establish paternity and we still have to do that. We consider it as a
term order.

Q -- Adoptions, if we establish paternity and the child is later adopted
and we have another case with the adoptive parents, do you code based on
adoption or do you leave the original birth father?

A - Wisconsin has the same situation. If a child is born out of wedlock
we count the child and they keep it as the original father.

A - Minnesota would update when adoption, then it may be out of the pool
of paternity kids but I am not sure.

Comment -- Was the child born out of wedlock? Yes or no per our auditor.
How you work the cases afterward, you can have a child born in a legal
marriage but.

Q -- IV-D states, for children born of a marriage where there is a
subsequent marriage and the husband is not the father, you get the
subsequent father, how do you code for out of wedlock?

A - Minnesota would call it born out of wedlock because we wouldn't have
a legal father to establish for a court order. We had a similar case
where mother was married but refused to add a father's name. It depends
on what you have but auditors are good at looking at details of gray
situations.

Comment -- if may be helpful to look at your statute. She's married but
the father is not her husband. It is listed as out of wedlock. Take a
look at the language in your statute.

Comment -- Our language is tight. We have to report born of marriage
even if the guy was in prison for 20 years. We have to prove it before
we can go after the father.

Comment -- Born of marriage is born of marriage; that the father is not
the husband, functionally you have to establish paternity but that child
has paternity based on the marriage. We don't have to go back and change
born of marriage. They just remove the husband's name as the father.

Comment -- We would consider the second man to be substituted as the
father to a child born in wedlock. We would never change the born in
wedlock. We would never change our code. The second man would be the
legal father. We would have adjudicated paternity but it would not be
counted on line 6 because child was not eligible on line 5. It goes back
to uniformity of rules of vital statistics. While we are being compared
to each other, it is not a strict comparison of like events.

OCSE (Kim Smith) It is not always a strict comparison. It is very
important that you know your state statute. States have explicit
statutes sometimes. We have found situations where states have recorded
things opposite of what their statute states. Study your statutes to
make sure you are in compliance with your rules. In some situations
Federal regulations aren't prescriptive.

### Group 2 {#group-2-1 .unnumbered}

Q -- I wanted to ask Colorado, the Vital Records folks say they are
audited by national. Either yours are lying to you or ours are lying to
us. They do not audit birth records. It's more how many people died of
cholera. There is no incentive for them to keep their data clean.

A -- There isn't a standard they have to live up to. They have to answer
to Apgar scores and they have a big world apart from us.

Q- How do you capture legitimizations when parents marry after the birth
of a child and it is not an IV-D case?

A - I am missing those completely and not adding them into paternity at
all. It is not a significant number and would not change my percentage.
Not a significant number.

(Oklahoma -- Vital Records Staff)

### Group 3 {#group-3-1 .unnumbered}

Q -- For Anne, two questions: how much time did the audit take for
switch? Are you glad you switched?

A -- We are glad we switched. We feel we have more control over the IV-D
data. Our Department of Health is doing some system changes and we may
look at a change. In terms of audit, the auditor didn't realize we had
switched rates at first but he had his sample of cases and he looked at
paternity in the files. He reviewed that year's cases for IV-D. He still
had his case sample from the previous year. He did have to review some
cases. Not sure how he reconstructed the sample in FY 99. It didn't seem
overly burdensome for him to us.

Q -- Comment about auditors. There seems to be a theme that there is a
difference between auditors. Our auditors congratulate us on how well
we've done and prepared for them. They stayed for six week for the past
two years. I'm hearing a week and I'm shocked. And we have two auditors.

Q -- Don't they have a standardized audit instrument?

A -- It was one week to come out and re-audit. The auditor had already
been in the state two or three weeks and done work remotely.

A -- Georgia is Atlanta where the auditor sits. They spent more time in
Oklahoma. Georgia has a four to six week process.

A -- Minnesota, in 2004 had auditors out for four to six weeks and we
still haven't gotten audit report.

Q - Can the Feds answer; do they have a standardized audit instrument?
You can't tell if you are going to pass. Why isn't it that the
information is available at the state to see the audit instrument in
advance? Is it a secret what they are going to look at?

A -- OCSE (Kim Smith) We do have a standards audit process that is based
on the 157 requirement. It is both manual and automated. It (the audit)
varies by state and how your (state) system is set up, as well as your
statutes. With paternity we don't have one standardized paternity review
process, because we are looking at two options, statewide or IV-D PEP so
you can't compare. Statues affect how the auditors perform their
reviews. One auditor may find doing step 5 through 10 first and then 1
through 4 better and another may do steps 1 through 10 sequentially, but
they have to hit all the steps. It depends on how easy the auditor can
move through your system. It helps to give them remote access. I am not
sure I understand the second part of your question. The 157 instructions
don't change. The random sample does change. You could do well one year
but with a different sample your results could vary.

Q -- We are trying to switch from statewide to IV-D because our numbers
are bad. We decided to audit ourselves. She (the auditor) shared her
actual form. I don't know if that is something standard or if she
prepared it on her own. We don't think we could pass data reliability if
we switched. If we knew this years ago, we would be prepared.

A -- What she may have had may have been based on what she knows of your
state. As far as a form for every state we don't have that because it
(the paternity review) varies too much.

Q -- What I've heard here at least from state to state is that the
auditors ask for different levels of information. We have given remote
access. When our guys come in, we get two auditors; they camp out for 6
weeks. We've had them for two months. The documents, once they look in
the system, they want marriage certificates, birth certificates, IV-A
applications, Medicaid. It's a standard not being applied across the
board. Some state have to supply more documents than others. I'm not
sure the standards apply equally from region to region.

A -- I've heard a lot of states saying they do their entrance on
location then go back and sample remotely. Some states capability is
that auditors don't have to be on site but the auditors come back and go
to Vital Records. Some states mail copies. Auditors have to review hard
copy documents and that should be standard across the country.

Comment -- It's not.

A -- If it is not, we should know.

Comment -- In California we have the auditors out and they do exactly
that. They go out to the counties and they do a hard copy review. The go
to Vital Records. We failed in 2000 and in 2001 and were in danger of
losing our block grant. We now require each county to review a certain
number of cases. They do a mini audit and it is based on the 157
instructions. Simple questions like was paternity established during the
FFY, simple things the auditors find and we get written up for. We
passed at 99% and have been at 100% since then.

Q -- You said that Vital Records is used for the statewide PEP and there
was one error in three years. When talking about data reliability do
auditors go to Vital Records for out of wedlock births or do you
maintain that in your STARS system?

A - We have two. The auditor goes to Vital Records and views the
paternity documents. He also views the out of wedlock birth records.
Those records are updated in STARS. Then he views our records and we are
required to provide all the documents Ted was talking about. He gives us
a list. I change the date on the form and ask the workers to send in the
documents. When he comes in he doesn't have to take his time to print
out the documents. He goes to Vital Records and audits our records too.

Q - How do you legitimize IV-D and adoption?

A - Those orders come into the case state registry, STARS. We have the
court orders on those and provide them to the auditors if they come up
in the sample. We don't capture legitimization yet but will on July 1
when the new law kicks in. Email <crmoss@dhr.state.ga> for more
information.

#  Appendix B -- Meeting Agenda

**AGENDA FOR State Paternity Mentoring**

+-----------+---------------+-----------------------------------------+
| *         | **            | **Description**                         |
| *Monday** | Performance** |                                         |
|           |               |                                         |
| **June    |               |                                         |
| 20, 005** |               |                                         |
+===========+===============+=========================================+
| **6:00pm  | Registration  | Receive name badges and notebooks       |
| to\       |               |                                         |
| 8:00pm**  |               |                                         |
+-----------+---------------+-----------------------------------------+
| **        | **            | **Description**                         |
| Tuesday** | Performance** |                                         |
|           |               |                                         |
| **June    |               |                                         |
| 21,       |               |                                         |
| 2005**    |               |                                         |
+-----------+---------------+-----------------------------------------+
| **7:00am  | Registration  | Receive name badges and notebooks       |
| to\       | & Breakfast   |                                         |
| 8:00am**  |               |                                         |
+-----------+---------------+-----------------------------------------+
| **8:00am  | Introduction  | Welcome statement of Workshop Purpose,  |
| to\       | to the        | Goals, Objectives, and Explanation of   |
| 8:30am**  | Workshop      | Workshop Format. House Keeping and      |
|           |               | Administrative Announcements.           |
|           |               |                                         |
|           |               | **(Mrs. Joyce Pitts, Director -         |
|           |               | DPRE/OCSE, Mr. Leon McCowan - Regional  |
|           |               | Administrator, Mr. John Bobeck -        |
|           |               | Facilitator, and Mrs. Paula Cottrell -  |
|           |               | Note taker)**                           |
+-----------+---------------+-----------------------------------------+
| **8:30am  | Presentations | **Colorado and Oklahoma**               |
| to\       |               |                                         |
| 10:00am** | PEP           |                                         |
|           | Performance   |                                         |
+-----------+---------------+-----------------------------------------+
| **10:00am | Break         |                                         |
| to\       |               |                                         |
| 10:30am** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **10:30am | Presentations | **Oregon, Montana, and Texas**          |
| to**      |               |                                         |
|           | PEP           |                                         |
| **        | Performance   |                                         |
| 12:30pm** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **12:30pm | Lunch         | Provided                                |
| to        |               |                                         |
| 1:30pm**  |               |                                         |
+-----------+---------------+-----------------------------------------+
| **1:30pm  | Presentations | **Wisconsin, Minnesota, and North       |
| to**      |               | Dakota**                                |
|           | IV-D          |                                         |
| *         | Performance   |                                         |
| *3:00pm** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **3:00pm  | Break         |                                         |
| to**      |               |                                         |
|           |               |                                         |
| *         |               |                                         |
| *3:30pm** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **3:30pm  | Presentations | **Virginia and Georgia**                |
| to**      |               |                                         |
|           | Statewide     |                                         |
| *         | Performance   |                                         |
| *5:00pm** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **5:00pm  | Summ          | Adjournment                             |
| to**      | ary/Feed-Back |                                         |
|           |               |                                         |
| *         |               |                                         |
| *5:15pm** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **We      | **DRA**       | **Description**                         |
| dnesday** |               |                                         |
|           |               |                                         |
| **June    |               |                                         |
| 22,       |               |                                         |
| 2005**    |               |                                         |
+-----------+---------------+-----------------------------------------+
| **7:30am  | Light fare    |                                         |
| to\       | Breakfast     |                                         |
| 8:30am**  |               |                                         |
+-----------+---------------+-----------------------------------------+
| **8:30am  | Data          | **Wisconsin, Minnesota, and North       |
| to\       | Reliability   | Dakota**                                |
| 10:00am** |               |                                         |
|           | IV-D States   |                                         |
+-----------+---------------+-----------------------------------------+
| **10:00am | Break         |                                         |
| to\       |               |                                         |
| 10:30am** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **10:30am | Data          | **Colorado, Oklahoma, Oregon, and       |
| to**      | Reliability   | Virginia**                              |
|           |               |                                         |
| **        | Statewide     |                                         |
| 12:30pm** | States        |                                         |
+-----------+---------------+-----------------------------------------+
| **12:30pm | Lunch         | Provided                                |
| to**      |               |                                         |
|           |               |                                         |
| *         |               |                                         |
| *1:30pm** |               |                                         |
+-----------+---------------+-----------------------------------------+
| **1:30pm  | Data          | **Georgia and Minnesota**               |
| to**      | Reliability   |                                         |
|           |               |                                         |
| *         | States that   |                                         |
| *3:00pm** | switched      |                                         |
|           | PEP's         |                                         |
+-----------+---------------+-----------------------------------------+
| **3:00pm  | Discussion    | Wrap-up and Adjournment - **Mr. John    |
| to**      |               | Bobeck - Facilitator**                  |
|           |               |                                         |
| *         |               |                                         |
| *3:30pm** |               |                                         |
+-----------+---------------+-----------------------------------------+

#  Appendix C - Attendees

Alabama

> Sheila Lane
>
> Patricia Taft

Arizona

> Leisa Bell
>
> Sherry Seaman

Arkansas

Mary Smith

Gary Tackett

California

Karen Echeverria

Lupe Gonzales

Colorado

Robert Conklin

Connecticut

John Dwyer

Karen Main

Delaware

Gwen Anderson

Barbara Lamont

District of Columbia

Joseph Allen

William Pinkett

Florida

Nancy Luja

Lynn Pesic

Georgia

Cindy Moss

Robert Riddle

Guam

Diane Blas

Barbara Cepeda

Idaho

Leslie Betty

Kim Lafferty

Illinois

David Scoville

Indiana

Daphne Risch

Wendy Yerkes

Iowa

Carla Forcier

Catherine Tesar

Kansas

Ralph Malott

Brian Windmeyer

Louisiana

Lisa Andry

Robbie Endris

Maryland

Joseph Jackins

Fran Johnson

Massachusetts

Joan Fahey

Michele Monahan

Michigan

Mark Jasonowicz

Pamela McKee

Minnesota

Anne Lauer

Brenda St. Sauver

Mississippi

Jean Bridges

Walley Naylor

Missouri

John Mier

Gloria Townsend

Montana

Tina Green

Deb Nason

Nebraska

Randy Cramer

Daniel Redler

Nevada

Louise Bush

Gary Stagliano

New Hampshire

Sarah Kourian

Kevin Landry

New Jersey

Patricia Risch

Thomas Vitella

New Mexico

Anthony De Marnello

Valerie Powers

New York

Leslie Robbins

North Dakota

Paulette Oberst

Teresa Peterson

Ohio

Lee Ann Cooper

Al Marcinonis

Oklahoma

Anthony Jackson

Freddy McCroskey

Oregon

Bill Bell

Brian Thompson

Pennsylvania

Georgia Lyons

Carol Sims

Rhode Island

Robert Farley

Edward Keenaghan

South Carolina

William Isgett

Dennis Yongue

Tennessee

Charles Bryson

Susan Welchance

Texas

Joan Hutcheson

Kevin O'Keefe

Utah

Steven Burton

Shauna Hair

Vermont

Mary Brown

Alyssa Chaffee

Virgin Islands

Regina de Chabert

Carolyn Thomas

Virginia

Connie White

Nick Young

West Virginia

Betty Justice

Karen Yahr

Wisconsin

Patti Reuter

Wyoming

Brenda Lyttle

Jay Mullendore

ACF

Valerie Kelly

Ron Gardner

John Moody

Lloyd Peery

OCSE

Nina Campbell

Sheck Chin

Joyce Pitts

Nehemiah Rucker

Kimberly Smith

SITC

John Bobeck

Paula Cottrell

Sheila Drake

[^1]: See Appendix B for the final agenda.