Child Fatality/Near Fatality Ingestion Analysis

Current information

The 2008 Act 33 Amendment to the Pennsylvania Child Protective Services law requires state and local reviews of all child fatalities and near fatalities that result from suspected child abuse. In response, the Allegheny County Department of Human Services (DHS) conducts a comprehensive and multidisciplinary review of child fatalities and near fatalities in cases where there is suspicion of child abuse or neglect. These reviews are a component of DHS’s continuous quality improvement process.

This report covers child fatalities and near fatalities (critical incidents) in Allegheny County reviewed in 2022 and 2023 with a focus on drug ingestions, which have been a growing cause of these critical incidents. The increase in child ingestions and fatalities has been a nationwide trend in recent years and has worsened amidst the nation’s opioid epidemic. The County seeks to understand how these incidents happen and the circumstances surrounding them so that it can develop strategies to minimize them.

  • There were 50 critical incidents that occurred during 2022 and 2023. Forty percent (20) of these incidents were the result of unintentional drug ingestion. Unintentional ingestion comprised one-third of the 2022 incidents, rising to nearly one-half in 2023. The number of ingestion-related incidents has been rising year-over-year since 2019 and has been the primary cause of the County’s fatalities and near fatalities since 2022, surpassing blunt force or penetrating trauma and abusive head trauma.
  • In 18 of the 20 ingestion cases, at least one of the substances ingested was an opioid. Eighty-six percent of the near fatal and 100% of the fatal ingestions involved opioids.
  • The majority (70%) of ingestions occurred in children below the age of three. 40% of victims of ingestions were between one and two years of age compared to 27% of victims of non-ingestion fatalities and near fatalities. This age group are especially at risk for unintentional ingestion as they begin to gain mobility, which increases the likelihood of coming into contact with substances.
  • Only 4 (20%) families of ingestion-related critical incidents had active child welfare involvement at the time of the incident, though three quarters (15) of families had a history of child welfare involvement prior to the ingestion incident.
  • Sixty-six percent of alleged perpetrators in ingestion cases had received publicly funded substance use disorder services prior to the critical incident.  However, there was a reduction in engagement with these services within a year (43%) and within a month (36%) prior to the critical incident.
  • Of the known alleged perpetrators in ingestion cases, 41% had utilized medication for opioid use disorder (MOUD) at some point before the critical incident. There was a steady decrease in MOUD use leading up to the critical incident with 31% using MOUD within the year and 13% within the month prior to the critical incident

Allegheny County is taking an active role in addressing the ramifications of the opioid epidemic and the rising trend of unintentional ingestions. This includes enhanced training for Child welfare staff and access to naloxone, lockboxes and fentanyl test strips for caseworkers to provide to clients. The County, through its opioid settlement funds, has expanded convenient access to MOUD and evidence-based treatment (e.g., mobile medication, telemedicine prescribing, and incentives for abstinence from stimulants and opioids) and launched a Countywide marketing campaign in April 2024 warning about the dangers of opioid ingestions and the safety of administering naloxone to children. In addition, it has invested in preventative programming like residential substance use disorder treatment that allows families to reside together during a person’s treatment and in the Hello Baby approach, a collaboration which is designed for parents with newborns to improve family outcomes and maximize child and family well-being, safety and security.

Explore updated annual data and prior reports here.

Allegheny Go Program: Interactive Dashboard

The Allegheny County Department of Human Services (DHS) partnered with Pittsburgh Regional Transit (PRT) to launch a transportation assistance program called Allegheny Go. This program offers half-price PRT rides for county residents ages 12 to 64 who receive Supplemental Nutrition Assistance Program (SNAP) benefits, and do not receive any other transit fare discounts. 

Allegheny Go builds on the success of the Allegheny County Discounted Fares Pilot Program, which ran from November 2022 through June 2024.  

This dashboard describes the application process and reports on application statistics and participant demographics.  

DHS has set a goal of enrolling 15,000 participants in Allegheny Go. This dashboard tracks progress towards that goal. Staff monitor how many applications are received, how many are eligible, and make sure eligible participants receive their discounts.  

Allegheny County Opioid Settlement Projects

Current Plan and Related Documents

Overview: 

In 2021 and 2022, states and localities reached historic settlements with manufacturers and distributors of opioids, as well as pharmacy chains and a consulting firm, for their roles in the opioid epidemic. The settlement funds were designed to promote the long-term goals of (1) reducing fatal overdoses and (2) reducing the harms from opioid use disorder. As a result of these settlements, Allegheny County will receive annual payments in varying amounts through at least 2038. To date, Allegheny County has received two payments in 2022 totaling $8.4M and a third payment in 2023 totaling $6.05M.

Analysis: 

This report is meant to provide background on the national opioid settlements and share updates on how Allegheny County invested the first two payments received from opioid settlements to bolster our ongoing investments in the broader substance use services system. The dashboard provides additional information about the fund and the initiatives the money is supporting.

Trouble viewing the dashboard below? You can view it directly here.

Allegheny County Department of Human Services developed these dashboards to provide information to the community about violence trends in Allegheny County and the City of Pittsburgh.

What is this dashboard about?

The dashboard contains information about all homicides in the county and city (as reported by the county’s medical examiner) and contains a link to the Pittsburgh Bureau of Police’s dashboard showing shootings within the City of Pittsburgh. The dashboard shows trends in homicides, including trends in demographic data for victims and trends in homicide locations. The dashboard also shows information on human service, physical and behavioral health, income supports and justice involvement for the victims prior to their death.

What data is available?

Data on homicides is available through the Allegheny County Medical Examiner’s office. It is available from 2007-present and is updated monthly. Data on program involvement (including prior justice involvement) comes from Allegheny County’s data warehouse, which integrates information from more than 20 distinct sources. Read more about the county’s data warehouse here.

Predictive Risk Models in Child Welfare

Current information

Since 2016, the Allegheny County Department of Human Services (DHS) in Pennsylvania has utilized the Allegheny Family Screening Tool (AFST), which assists child welfare call screening caseworkers in their assessment of general protective service (GPS) referrals regarding potential child maltreatment.

What is this report about?

This report reviews the research evidence on algorithms in child welfare, specifically focusing on the causal impacts of the AFST and comparable predictive risk models (PRMs). It begins by summarizing the influence of these tools on child welfare decisions. The report then explores the discrepancies between perceived and actual effects of these models, highlighting the importance of bridging the gap between perception and reality to alleviate concerns and maximize the effectiveness of these tools.

What are the takeaways?

The impacts of predictive risk models in child welfare must be compared with alternative approaches to augmenting call screening caseworker decision-making. Traditional risk assessments in child welfare have been largely manual, prone to inconsistencies, and often omit critical information. Before implementing the AFST, Allegheny County did not employ any structured risk assessment.

The main conclusions from recent research on the AFST are:

  • The AFST changed the composition of investigated referrals. The introduction of the AFST decreased the probability of investigation for referrals with low risk of removal and increased the probability of investigation among referrals with high risk of removal. The introduction of the AFST also reduced the racial gap in investigation rates, particularly among higher risk referrals.
  • The AFST is reducing, not increasing, racial disparities. Researchers found that the introduction of the model reduced racial disparities in investigation rates across AFST scores, although the size and precision of the reduction varied. The AFST reduced the racial disparity in investigation rates for the highest risk referrals by 83%, from 10.6% to 1.8%. The researchers estimated that the AFST reduced the Black–White gap in removal rates of screened-in referrals by 73%, from 4.3% to 1.2%.
  • Screeners use the algorithm but with caution. Researchers found that call screening case workers are integrating information from the AFST effectively, aligning their decisions more closely with predicted removal risk compared with the period before the tool’s introduction. The tool is seen as a helpful source of additional information rather than a replacement for professional judgment. 

How is this report being used?

The application of algorithms to support decision-making, especially in sensitive areas like child welfare, mandates high transparency. It is critical that the complexities of predictive risk models are communicated clearly to all stakeholders to maintain trust and prevent misuse. DHS is committed to keeping the public informed about the use and impact of algorithms at the Department and draw upon current research to shape the implementation of these tools in the field.

Read more about AFST here.

Allegheny County Discounted Fares Pilot Program

Current Plan and Related Documents

The Allegheny County Department of Human Services (DHS) partnered with Pittsburgh Regional Transit (PRT) to launch a new transportation assistance program in November 2022 called the Discounted Fares Pilot. This program offered free and reduced-price PRT rides for county residents ages 18 to 64 who receive Supplemental Nutrition Assistance Program (SNAP) benefits, along with their 6- to 17-year-old children. The fare discounts were allocated using a lottery. Each household in the pilot was randomly assigned to one of three groups, each with equal probability. One group received unlimited free PRT trips, a second group received a 50% discount on all PRT trips, and a third group received no discount. The fare discounts lasted for at least 12 months for the free-fare and half-fare groups.  

What is this report about?

This report first describes the results from the first year of the pilot.  It describes the design of the pilot, the characteristics of the participants and provides estimates of the causal impact of the fare discounts on travel behavior and health care utilization.  It also reports on impacts on self-reported outcomes related to employment, financial stability, and well-being.

What are the takeaways?

  • A total of 9,544 adults and 4,928 children enrolled in the Pilot during the three-month open enrollment period. The majority of adult participants were female (72%) and Black (59%). Participants reported taking an average of ten PRT trips per week and spending an average of nearly $30 on public transportation per week at the time they enrolled in the Pilot.
  • Most participants successfully received their Pilot-issued farecard and used the card at least one time. 90 percent of adults in the free-fares group tapped their assigned farecard at least once. 82 percent of the half-fares group and 81 percent of the no-discount group tapped their farecard at least once. The majority of farecard non-users likely never received their assigned card.
  • Larger fare discounts resulted in greater use of Pilot-issued farecards. Participants in the half-fares group tapped their assigned farecards an average of 1.6 more times per week than the no-discount group. Participants in the free-fares group tapped their assigned farecards an average of 3.3 more times per week than the half-fare group. 
  • The fare discounts yielded improvements in certain measures of financial savings and transportation security. In particular, the free fares reduced self-reported weekly spending on PRT trips by more than $17 relative to no discount while there was an $8.92 decrease in weekly spending on average for the 50% discount group. Free fares led to a 26 percentage-point decrease, while 50% discounts resulted in a 10 percentage-point drop in the self-reported likelihood of missing work or other appointments in the past four weeks due to transportation issues.
  • Discounted fares had limited effects on health care utilization, with no clear patterns emerging in terms of increased or decreased use of care. The fare discounts had no discernible impact on participants’ likelihood of receiving Medicaid-funded health care in the first 270 days after they enrolled in the Pilot.

How is this being used? 

DHS is using the Pilot results to better understand the ways that low-income households may benefit from reduced PRT fares. We will continue to refine our understanding by analyzing longer-term outcomes and by incorporating insights from qualitative interviews that were conducted with a subset of participants. These findings will be shared in a future publication.

DHS has also used the preliminary Pilot results to inform the design and implementation of a longer-term program that will offer a 50% PRT discount for working-age county SNAP beneficiaries and their children. This new program, called Allegheny Go, is scheduled to launch in June 2024.

Other information

Research Plan

Each year, Allegheny County participates in a national census, required by the U.S. Department of Housing and Urban Development (HUD), of the number of people experiencing homelessness on a single night. The Point-in-Time count enumerates people experiencing homelessness in the County who are sheltered (residing in emergency shelters), unsheltered (residing in places not meant for human habitation) or participating in a short-term, supportive housing program (transitional and safe haven).

While the Point-in-Time count allows for annual comparisons, DHS also maintains a real-time dashboard that tracks the daily number of people in emergency shelters and a weekly count of people known to be experiencing unsheltered homelessness based on their engagement with street outreach teams. 

What are the key takeaways from the 2024 count?

  • On January 30, 2024, in Allegheny County, 1,026 individuals were staying in emergency shelters or experiencing unsheltered homelessness (compared to 913 in 2023).  
    • 857 were staying in emergency shelters (84% of overall count)  
    • 169 were unsheltered (16% of overall count)  
  • An increase in the number of individuals staying in emergency shelter (+99) is largely responsible for the increase in the number of people experiencing homelessness in the 2024 count. 
  • The number of individuals experiencing unsheltered homelessness increased (+14) since 2023, but the percent increase of 8% is smaller than the year-over-year increases in 2022 and 2023, which were 62% and 48%, respectively. 
  • Adult-only households differ from adult-child households both demographically and in how they access and use shelter, which is why we look at these populations separately in this year’s brief. 
  • Among individuals in adult-only households (n=702): 
    • The majority (76%) were staying in shelters. 
    • Men were overrepresented in both sheltered (64%) and unsheltered (66%) locations. 
    • White adults were more likely to be unsheltered (57%) than adults of other races, but Black adults were overrepresented in shelters and in unsheltered locations, as Black individuals make up only 14% of the County’s population. 
    • The unsheltered adult population skewed slightly younger than those who were in shelter; a third of sheltered adults were 55+ (vs. 13% of those unsheltered). 
    • Veterans made up a small percentage of both the sheltered (7%) and unsheltered (5%) populations.  
    • There were 30 adult survivors of domestic violence in shelter (6%); in surveys, an additional three unsheltered individuals mentioned intimate partner violence as a factor leading to their homelessness. 
  • Among the 324 individuals in adult-child households, all of whom were staying in shelter: 
    • Women/girls were overrepresented (61%), skewed by female-headed households. 
    • Black individuals were significantly overrepresented, at nearly 70% of those in family shelters. 
    • There were 93 unique households and they tended to be younger families; most adults were under 45 and 60% of the family shelter population was under 18. 
    • Almost a quarter of adults staying in family shelter were survivors of intimate partner violence.

How are these reports used?

The data collected during the yearly Point-in-time is submitted to HUD, to create a yearly homelessness assessment report presented to congress. For more information, visit the HUD website on the Point-in-Time Count, linked here.

Allegheny County uses the yearly data as a component of its work to understand trends and needs, informing the County’s strategies to reduce homelessness and better serve those experiencing it.

Previous Reports in this series

DHS Goals and Key Initiatives: 2024

Current information

DHS has set five goals to guide us and our partners in serving our community well. We aim for our network for human services to improve access to care, prevent overuse of coercive services, prevent harm, increase economic security and ensure quality.

What is this report about?

DHS can reach our goals more quickly if we devote time and attention to several big, bold initiatives that will make our systems and our organization work better for everyone we serve. This document outlines our key initiatives in 2024—which are in addition to our core work of running effective systems of care for people.

DHS 2023 Accomplishments

Current information

County human services includes programs from over 300 community-based agencies and is delivered by social workers, peers, and outreach staff working all throughout the county. These staff run out-of-school-time programs, answer hotlines, investigate reports of potential harm to children and vulnerable adults, deliver meals to seniors and run Senior Centers, make home visits to families with newborns, and do the administrative work that makes our human services run efficiently.

What is this report about?

This report highlights the 2023 accomplishments that stood out. There are many, many other achievements that people told us about. We chose the ones that made the biggest difference.

Current Information

Allegheny County DHS sends text messages to county residents for a variety of reasons, including increasing awareness of services, providing timely reminders, and gathering feedback after a service experience.  In addition, DHS uses this information to help evaluate and monitor programs it delivers.  This dashboard displays information about these outreach and engagement efforts, including the subject and purpose of these and the rates of engagement.  Data on DHS’s texting efforts are available from November 2017 to the present.

The dashboard allows users to examine DHS text messaging as a whole as well as drill down to individual text campaigns.  It allows users to understand the purpose of each campaign, the number of messages sent and the demographics of the people being contacted by each campaign.  DHS collects this information through Community Connect Labs (CCL), DHS’s texting software, and information is updated daily. Click here for a more detailed report on DHS’s texting outreach from 2018-2022.

In Allegheny County, a network of shelters provides temporary places to stay for people experiencing homelessness. Allegheny County’s emergency shelter network includes facilities that serve only adults and others that offer spaces to families with children or other dependents (family shelters).

This data brief focuses on the group of approximately 598 people in 184 households that enrolled in one of six family shelters at least once from April 2022 through March 2023. People are eligible for family shelters if they are 1) an adult with a minor child(ren) or a child over 18 years old still enrolled in high school, 2) a woman or couple without a minor child where the woman is in her third trimester of pregnancy, or 3) a couple unable to separate or parent with an adult child where one is caregiving for the other.

See the related data briefs, “People Using Adult-Only Emergency Shelters in Allegheny County” and “People Experiencing Unsheltered Homelessness in Allegheny County for descriptions of other people served in the homeless system

  • Ninety percent (N=165) of heads of household who used family shelters were female and Black individuals were over-represented – 77% of heads of households were Black, but Black individuals only make up 14% of the county. Most households (71%) consisted of an adult female head of household and one or more children. Forty-nine percent of children (N=179) were age 5 or younger at the time they entered a family shelter. An additional 35% were ages 6 through 12 and 16% were ages 13 through 17.
  • Most families had not recently used the shelter system and only stayed once. 84% of families only used shelter once during this period and only 6% had used a shelter or County housing program in the year prior to their first stay.
  • Although half of families stayed in shelter for more than two months, the largest group of families exited within a week of entering. Seventy-nine percent (N=153) of all stays resulted in households exiting to stable housing, which includes a County housing program (32%), housing with family or friends (27%), or an owned or rented property (19%). An additional 19% exited to another shelter.
  • Income is limited for heads of household using family shelters. 70% (N=129) of heads of household self-reported income from any source, with an average monthly income of $923. Additionally, DHS was able to access Pennsylvania Labor and Industry information for 171 individuals in this cohort (93%). Of these heads of household, 47% (N=81) had earnings, with an average monthly income of $1,243.
  • About a third of Medicaid-enrolled heads of household used behavioral health services, most of which were mental health outpatient services. The most common diagnosis was acute stress disorder (30% of people with a diagnosis), a short-term mental health condition that can occur within the first months after experiencing a traumatic event.
  • Asthma was the most common chronic condition for Medicaid-enrolled children using shelter and the second most common for heads of household. Asthma rates for both are twice as high as those in the general Medicaid-enrolled population in the County
  • Fifteen percent of families using these shelters had an active child welfare case in the year prior to their stay. This could indicate the need for additional support and safety nets within the child welfare system or as families transition out of it.

Emergency shelters are meant to be short-term accommodations for people experiencing a crisis. The County’s goal is to ensure that shelter stays are rare, brief and non-recurring.  The County is working with shelter staff and other housing providers to support client moves to stable housing when possible, with the goal of improving their overall outcomes and ensuring that short-term beds are available when people need them. 

In Allegheny County, a network of shelters provides a temporary place to stay for people experiencing homelessness. Allegheny County’s emergency shelter network includes facilities which serve adults only and others that offer accommodations to families with children or other dependents. The County strives to ensure that every shelter stay is rare, brief and non-recurring.

Individuals in adult-only households make up about three-quarters of all shelter users. This data brief focuses on the 1,560 adults who entered one of the County’s 13 adult-only emergency shelters once or more from April 2022 through March 2023..  For descriptions of other people served in the homeless system, see these related data briefs: “Families using emergency shelters in Allegheny County” and “People Experiencing Unsheltered Homelessness in Allegheny County.

  • 70% (N=1,096) of the people using adult-only shelters were men. Black individuals were overrepresented, making up 51% of those using shelter but only 14% of Allegheny County’s population. 80% of people were between 25 and 64 years old and relatively evenly distributed among the four age groups in that range. 13% were ages 18 through 24 and 7% were 65 or older.
  • 76% (N=1,181) of people had only one shelter stay during the period of study. 15% had two stays and 9% had three or more.
  • Half of the shelter stays were for two weeks or less. 25% of shelter stays lasted five days or fewer and 75% were for 54 days or fewer.
  • Most of the people using shelters had recent addresses in Allegheny County communities. 46% had recent addresses in the City of Pittsburgh, with the most common neighborhoods being Carrick, East Liberty, Marshall-Shadeland and Sheradan. The remaining 54% had addresses outside of the City, with the most common municipalities being McKeesport, Wilkinsburg and Penn Hills.
  • Among shelter exits for which we have exit information, 49% (N=760) of stays resulted in exits to stable housing.  Almost half of the people who exited their stay(s) within two weeks exited to stable housing, increasing to 58-65% of people who exited their stay(s) after a month.
  • Less than half of individuals reported income from any source. PA Department of Labor and Industry data provides some insight over time; about one-third of people using shelter were employed in any given quarter from 2017 through 2022. For those who were employed, wages averaged between $663–$1,017 per month.
  • 17% (N=259) of people had a shelter stay in the year prior to their first stay in the study period. 8% (N=132) were engaged in a supportive housing program in the year prior to their shelter stay.
  • Other services and system involvement:
    • Behavioral health services. Among adult shelter users enrolled in Medicaid (N=945), more than 75% accessed behavioral health services. 43% (N=404) accessed mental health outpatient care, 39% used a mental health crisis service and 15% used a mental health inpatient service. The most frequent mental health diagnoses were depressive disorder, adjustment disorder, schizophrenia and bipolar disorder. 35% (N=327) used a substance use disorder service. The top substance use disorders involve opioids and alcohol.
    • Physical health services. For Medicaid-enrolled individuals, the most common chronic condition was hypertension, followed by kidney disease and diabetes. Adults using shelter have higher rates of many chronic diseases than those in the general Medicaid-enrolled population in the County.
    • Criminal Justice System. About a third of people were involved with the adult criminal justice system in the year prior to their shelter stay.
    • Other services. Five percent (N=75) of adults were involved in child welfare as a parent. 20% (N=46) of older adults (aged 60+) using shelter were connected to aging services in the year prior to their entry.

Emergency shelters are meant to be short-term housing for people experiencing a crisis. The County’s goal is to ensure that shelter stays are rare, brief and non-recurring.  The County is working with shelter staff and other housing providers to support client moves to stable housing when possible, with the goal of improving their overall outcomes and ensuring that short-term beds are available when people need them.

Information for DHS contracted providers

Current Information

Allegheny County Department of Human Services (DHS) believes that appropriate sharing of client information is essential to the provision, continuity and overall quality of care provided to DHS clients. It has created a number of tools and mechanisms to facilitate this sharing, including the creation of tools for contracted providers to access information on clients they are serving and mechanisms for providers to safely and security share client information back with DHS. Read more about this here and access the tools through the below links.

Where can I access provider tools?

Links to clientivew, a tool for individual care coordination, and provider connect, a tool for to support provider decision-making, are found here. You can also access data exchange, one of the tools that providers can use to securely share information back with DHS.

How I can gain access to these tools if I don’t already have it?

If you are a contracted provider with DHS, you can request access to provider tools through DHS’s application support portal.