Setting

X10029.doc Version 1.40 Page 1 FOSTERING SERVICE

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Lead Inspector Jim Palmer Key Announced Inspection 15th January 2007 02:57 pm The Commission for Social Care Inspection aims to:

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• Put the people who use social care first • Improve services and stamp out bad practice • Be an expert voice on social care • Practise what we preach in our own organisation

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Reader Information Document Purpose Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Internet address www.csci.org.uk

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Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Fostering Services. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

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Every Child Matters, outlined the government’s vision for children’s services and formed the basis of the Children Act 2004. It provides a framework for inspection so that children’s services should be judged on their contribution to the outcomes considered essential to wellbeing in childhood and later life. Those outcomes are: • Being healthy • Staying safe • Enjoying and achieving • Making a contribution; and • Achieving economic wellbeing.

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In response, the Commission for Social Care Inspection has re-ordered the national minimum standards for children’s services under the five outcomes, for reporting purposes. A further section has been created under ‘Management’ to cover those issues that will potentially impact on all the outcomes above.

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Copies of Every Child Matters and The Children Act 2004 are available from The Stationery Office as above This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection.

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Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 3

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Name of service

Plymouth City Council Local Authority Fostering Agency

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Name of service

Address Social Services Floor 1, Ballard House Plymouth Devon PL1 2AA

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manager (if applicable)

Type of registration Local Auth Fostering Service

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manager (if applicable)

Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 4

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Conditions of registration:

Date of last inspection 7th November 2005

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Brief Description of the Service:

Plymouth City Council is a Unitary Authority in Devon. The Foster Care Service is a part of Children’s service provision within the city. At the time of the inspection the Plymouth Foster service was managed by three Managers; two were in temporary positions. The Service was overseen by the head of Children’s services who took up post just prior to the start of this inspection. The team had responsibility for recruitment selection, training and support of all the city’s foster carers

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Brief Description of the Service:

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SUMMARY

This is an overview of what the inspector found during the inspection.

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SUMMARY

This was an announced key inspection of the fostering service. The inspection took place between the 15 th . and the 19 th . January 2007. The inspection was undertaken by two inspectors and the views of children, foster carers, placing social workers, staff and managers were sought to enable the inspectors to make their judgements. The foster panel was observed and records were examined, along with staff files support group was attended and four foster carers were visited at home.

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SUMMARY

At the last inspection, in November 2005, 28 Statutory Requirements and 3 good practice recommendations were made. At this inspection one Statutory Requirement from the last inspection remains. A further seven good practice recommendations have been made.

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SUMMARY

A significant degree of improvement has been achieved. There was clear evidence of good management and strategic development. The potential now exists for this service to fully meet and possibly exceeds the national minimum standards. However many of the improvements are relatively recently introduced, and will require consolidation, before the full impact will be realised. Therefore despite these considerable developments the service can only be assessed as adequate at this stage. The managers and department should however be congratulated for the progress that has been achieved.

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SUMMARY

The inspectors would like to thank the young people, carers, staff and managers for the assistance and hospitality during the inspection.

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What the service does well:

The degree of commitment, enthusiasm and willingness to improve is recognised. Foster carers value the role of their supervising social workers.

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What the service does well:

The service provides very good individual packages of support to young people and carers through links with other agencies, such as the Number 11 project and specialist support to carers, particularly for children with complex needs.

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What the service does well:

The service has also developed excellent links with education, and works closely with the PLACE team, who work to meet the needs of looked after children.

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What the service does well:

The development of links with health service colleagues is also an example of good inter-agency working.

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What the service does well:

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What has improved since the last inspection?

Significant improvements have been made to the service since the last inspection. Managers and staff have worked with energy, enthusiasm and skill to reduce the 28 Statutory Requirements to 1. In addition to working to meet the requirements from the last inspection, the department has undertaken a number of positive developments within the service.

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What has improved since the last inspection?

Particular areas of improvement are as follows;

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What has improved since the last inspection?

joint training and planning between the fostering service and the looked after children team.

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What has improved since the last inspection?

developments to the role, constitution and training for the foster carer panel are welcomed.

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What has improved since the last inspection?

a reduction in the numbers of foster carers subject to exemptions from the usual fostering limit.

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What has improved since the last inspection?

review of the skills and payments scheme to carers

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What they could do better:

The service needs to maintain and consolidate the progress made.

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What they could do better:

It needs to continue to ensure that foster carers are provided with sufficient information, particularly medical information to ensure they can fully meet the needs of young people.

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What they could do better:

The service needs to improve ways in which it seeks the views of young people and their families.

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What they could do better:

Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.

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What they could do better:

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CONTENTS

Statutory Requirements Identified During the Inspection

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CONTENTS

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The intended outcome for this Standard is:

• The fostering service promotes the health and development of children.(NMS 12)

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JUDGEMENT – we looked at the outcome for Standard:

12. The service has taken significant measures are in place to ensure the promotion of good health outcomes for children Quality in this outcome area is good.

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JUDGEMENT – we looked at the outcome for Standard:

This judgement has been made using available evidence including a visit to this service.

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EVIDENCE:

Since the last inspection when a statutory requirement was made, a significant amount of progress has been made. The authority has appointed a LAC nurse; the LAC nurse is well integrated with the fostering service and is a member of the Fostering Approval panel. The service has developed good links with CAMHs and other therapeutic services; this is an area of strength within the service. One of these groups was visited during the course of the inspection, feedback from carers was that they were highly valued and were of great assistance in helping carers to maintain placements with children some of whom were exhibiting highly complex behaviours. This model has to potential to exceed the standard.

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EVIDENCE:

The authority has plans in place to monitor the health needs of children closely through the Independent Reviewing Officer role, and plans further developing the relationship between health professionals and the service.

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EVIDENCE:

A new post approval foster carer training programme has been introduced and this includes training for carers, in health promotion and awareness of sexual health issues.

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EVIDENCE:

Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 9 Individual training for carers of children with specific health needs has been introduced. Some foster carers confirmed that they have had training opportunities provided for them in a timely manner

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EVIDENCE:

The revised foster carer handbook gives specific advice to carers on meeting children’s healthcare needs. The degree of progress made to date is impressive.

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EVIDENCE:

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The intended outcomes for these Standards are:

• Any persons carrying on or managing the service are suitable. (NMS 3) • The fostering service provides suitable foster carers.(NMS 6) • The service matches children to carers appropriately.(NMS 8) • The fostering service protects each child or young person from abuse and neglect.(NMS 9) • The people who work in or for the fostering service are suitable to work with children and young people.(NMS 15) • Fostering panels are organised efficiently and effectively.(NMS 30)

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JUDGEMENT – we looked at outcomes for the following Standard(s):

3; 6; 8; 9; 15; 30 Significant improvements have been introduced to ensure the safety of children being looked after within the service. These have the potential for the service to be assessed as good or better, but have not been in place for sufficient time to evidence sustained improvement. Therefore the quality assessment in this outcome area is adequate.

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JUDGEMENT – we looked at outcomes for the following Standard(s):

This judgement has been made using available evidence including a visit to this service.

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EVIDENCE:

The authority has recently appointed a permanent manager to the service. Currently there are two team managers within the service, these posts are currently held by members of the strategic partnership, there are plans to recruit two permanent managers to these posts.

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EVIDENCE:

The managers in post have significant experience in managing family placement services, are able to provide a sound management base to the service. This standard is met.

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EVIDENCE:

There is evidence of a thorough assessment process for foster carers, and a rigorous approval panel process. Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 11 Foster carers had received unannounced visits from their supervising social workers, and supervision with carers was now taking place regularly. The quality of recording of these visits was however inconsistent. Health and safety checklists have been introduced for all foster carer homes along with training in health and safety awareness.

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EVIDENCE:

Each of the foster carer homes visited provided adequate and appropriate accommodation for the children and young people looked after.

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EVIDENCE:

The service has introduced a new policy for matching children with carers. Joint training has been introduced for both placing social workers and fostering social workers. New placement request and matching forms, consider cultural, ethnic, and language issues along with a risk analysis and identification of carers skills or additional training or support required. The majority of foster carers reported an improvement in the quality of information provided and improved evidence of good matching. This was not however universal and one carer did tell the inspector that she had received no written information on two children placed, nor had any placement planning taken place despite the children being in placement for approximately one month. The requirement from the previous inspection will remain.

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EVIDENCE:

The department has undertaken a number of structural and managerial changes, since the last inspection, this has led to a more unified approach and less of a gulf between placing social workers and the fostering service.

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EVIDENCE:

The service is reviewing the current payment scheme for carers and is intending introducing a scheme based on competencies and payments for skills. This again should improve matching considerations and inform more strategic service developments, by identifying areas in which the service is unable to make suitable matches. Monitoring of the placement requests and matching, is now more rigorously monitored by managers than previously, this is a welcome development.

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EVIDENCE:

The foster care panel was observed during the inspection, and an interview with the panel chair took place. Membership of the panel has been reviewed and this now fully accords with the regulation. The panel was rigorous and thorough, but sensitive to the feelings of carers or prospective carers. The panel was chaired in a highly skilled and professional manner. Panel members include a legal advisor and professional advisor. The chair and panel members have received training in their roles. The inspector was told that the quality of the information presented to panel had improved, the chair of panel told the inspector that the panel was able to monitor the quality of information provided and is able to contribute to quality assurance within the fostering service.

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EVIDENCE:

Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 12 Staff H.R. files were checked, those looked at held the information required, there was also evidence that registration for qualified social workers had been verified, a recommendation is made, that all documents are held on file and that specifically CRBs are held on file until first inspected by the regulatory body.

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EVIDENCE:

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The intended outcomes for these Standards are:

• The fostering service values diversity.(NMS 7) • The fostering service promotes educational achievement.(NMS 13) • When foster care is provided as a short-term break for a child, the arrangements recognise that the parents remain the main carers for the child.(NMS 31)

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JUDGEMENT – we looked at outcomes for the following standard(s):

The service has shown a commitment to the valuing of diversity, and the promotion of achieving positive educational achievement for young people. Quality assessment in this outcome area is good. This judgement has been made using available evidence including a visit to this service.

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EVIDENCE:

The new post approval training programme for all foster carers emphasises the importance of diversity and awareness of cultural and individual needs of children. I addition to the training provided for carers, the matching process has been strengthened to include specific training for carers who look after children from diverse cultural backgrounds, who may need to be placed with carers from different cultural backgrounds.

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EVIDENCE:

Monitoring of the matching process has also started to inform more targeted recruitment of carers from differing cultural backgrounds. Despite these measures, the majority of carers are of white British backgrounds.

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EVIDENCE:

The fostering service has developed a close partnership relationship with the Plymouth Looked after Children and Education (PLACE) team. The inspector met representatives of the place team and also attended as training evening for foster carers, in which members of the PLACE team promoted the importance, of educational achievement and gave practical advice and Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 14 guidance to carers as to sources of support when children are facing difficulties in school.

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EVIDENCE:

Foster carers were aware of the importance of ensuring that children and young people achieved their potential at school, carers spoken to were supportive to children and committed to ensuring that educational needs were met. Carers said that link workers did discuss the child progress at school with them. The new supervision forms recorded that discussions about education on some of the files seen, this indicated that some progress had been made in the area of monitoring educational achievement.

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EVIDENCE:

The practice handbook for carers also provides foster carers with advice and guidance about the importance of promoting educational achievement for young people.

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EVIDENCE:

The authority, monitors the educational achievement of looked after children, and consistently performs well against national indicators.

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EVIDENCE:

A number of initiatives have been introduced aimed at promoting self-esteem, and the service has developed a partnership, with the local football club aimed at improving literacy skills. The authority promote young people’s participation in educational activities, by financial support, for activities, continuing education and visits, and the cost uniforms and specialist equipment.

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EVIDENCE:

The short breaks service is being further developed by the service.

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EVIDENCE:

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The intended outcomes for these Standards are:

• The fostering service promotes contact arrangements for the child or young person. (NMS 10) • The fostering service promotes consultation.(NMS 11)

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JUDGEMENT – we looked at outcomes for the following standard(s):

The service actively promotes contact arrangements in accordance with care plans. The service has developed new systems for consulting with young people. Quality in this outcome area is good.

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JUDGEMENT – we looked at outcomes for the following standard(s):

This judgement has been made using available evidence including a visit to this service.

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EVIDENCE:

Contact arrangements are now included within the new placement matching documents, foster carers are provided with training and practice guidance emphasising the importance of maintaining contact in accordance with the care plan for young people. An element of the foster care allowance is included for covering the costs of transport to and from contact.

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EVIDENCE:

The majority of foster carers reported an improvement in the planning arrangements and payments, however carers reported that they still felt that at times the planning did not take into account the practical implications of making contact arrangements and the potential disruption this may cause to other children in place. More attention needs to be paid to these considerations in some placement planning.

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EVIDENCE:

Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 16 The service seeks the views of children and young people, about the service, via a number of processes. This would usually be in the young person’s LAC review; each young person has the opportunity to record their view in “ Your Care” booklet. The recently introduced placement request information also includes a section for recording the young person’s views about the proposed placement.

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EVIDENCE:

A working group is currently considering other ways of seeking this information from children with specific communication difficulties. There is a taped version available for children with visual impairment. These positive developments are welcomed

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EVIDENCE:

Children and young people are also able to contribute to the annual reviews of foster carers; a recommendation has been made that the service may wish to introduce a process of seeking feedback from children and their parents, following the ending of each placement rather than at the following foster carer review.

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EVIDENCE:

A foster carer forum has been introduced since the last inspection, and a new complaints procedure, which is also designed to help young people express their views on the quality of the service. A youth group has been established, the intention of this group is to provide a forum for young people to meet with elected members and professionals to express views on the service and how it could be improved.

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EVIDENCE:

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The intended outcomes for these Standards are:

• The fostering service prepares young people for adulthood.(NMS 14) • The fostering service pays carers an allowance and agreed expenses as specified.(NMS 29)

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JUDGEMENT – we looked at outcomes for the following standard(s):

The service has introduced measures aimed at improving the way in which it prepares young people for adulthood. Payments for carers have improved since the last inspection.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Quality in this outcome area is assessed as adequate.

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JUDGEMENT – we looked at outcomes for the following standard(s):

This judgement has been made using available evidence including a visit to this service.

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EVIDENCE:

The fostering service has included a section on preparing young people for adulthood, in the recently introduced training programme for carers. Not all carers have yet received this training. Guidance is also included in the foster carer practice handbook.

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EVIDENCE:

Young people said they felt adequately prepared for adulthood and foster carers said they had been given sufficient advice and guidance in working with young people in preparing them for living more independent lives, a recommendation is however made that this work be consolidated across the service.

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EVIDENCE:

The service has introduced a review of care leavers practice in response to the “Care Matters” green paper and has introduced joint workshops involving care leavers and the service, aimed at improving joint understanding, these positive developments are welcomed, however will need to be consolidated in order to bring about the required changes. Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 18 Feedback from carers confirmed that payments to carers was generally clear and understandable, the majority of carers felt that payments were made accurately and on time. However there were some issues linked to placement planning and the costs involved in transport arrangements linked to contact and the keeping of specific appointments.

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EVIDENCE:

The payments system is currently under review, and recommendations will be made in the near future. Most foster carers spoken with felt the payments system had improved since the last inspection.

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EVIDENCE:

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The intended outcomes for these Standards are:

• There is a clear statement of the aims and objectives of the fostering service and the fostering service ensures that they meet those aims and objectives.(NMS 1) • The fostering service is managed by those with the appropriate skills and experience. (NMS 2) • The fostering service is monitored and controlled as specified. (NMS 4) • The fostering service is managed effectively and efficiently.(NMS 5) • Staff are organised and managed effectively.(NMS 16) • The fostering service has an adequate number of sufficiently experienced and qualified staff.(NMS 17) • The fostering service is a fair and competent employer.(NMS 18) • There is a good quality training programme. (NMS 19) • All staff are properly accountable and supported.(NMS 20) • The fostering service has a clear strategy for working with and supporting carers.(NMS 21) • Foster carers are provided with supervision and support.(NMS 22) • Foster carers are appropriately trained.(NMS 23)

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The intended outcomes for these Standards are:

• Case records for children are comprehensive.(NMS 24) • The administrative records are maintained as required.(NMS 25) • The premises used as offices by the fostering service are suitable for the purpose.(NMS 26) • The fostering service is financially viable. (NMS 27) • The fostering service has robust financial processes. (NMS 28) • Local Authority fostering services recognise the contribution made by family and friends as carers.(NMS 32)

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JUDGEMENT – we looked at outcomes for the following standard(s):

1; 2; 4; 5; 16; 17; 18; 19; 20; 23; 24; 25; 28; 32.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Management and leadership of the service were good; however some key posts are currently being held as temporary posts and permanent appointments will need to be made in order to ensure progress is maintained as a result quality in this outcome area is assessed as adequate.

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JUDGEMENT – we looked at outcomes for the following standard(s):

This judgement has been made using available evidence including a visit to this service. Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 20

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EVIDENCE:

The Statement of Purpose has been reviewed, and has been updated to reflect the changes that have taken place within the service. The Statement of Purpose now accurately reflects the services that the service can provide. At the time of the inspection the new statement had been agreed but had been circulated to carers, that had however been advised that a new statement was about to be circulated. This standard is now met.

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EVIDENCE:

The service has recently notified the CSCI that it has now made a permanent appointment, to post of permanency and placement service manager. The recently appointed manager has substantial previous experience in both fostering and adoption work and is appropriately qualified and experienced. The manager is supported by three members of the strategic partnership, two of whom are currently holding team manager posts within the service. Prior to and for the duration of the inspection, the service has been managed in a temporary capacity.

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EVIDENCE:

Each of these managers has brought a wide range of knowledge and skill to the service.

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EVIDENCE:

A new strategic structure has been introduced, and a combined looked after children team has brought greater cohesion and joint working approach to both the fostering service and the care management team. Whilst this is not being made as a formal recommendation the view of the inspectors is that benefits may be gained by the consideration of a joint location for both the fostering service and the looked after children team.

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EVIDENCE:

It is essential however that in order to maintain the substantial positive developments that have been achieved under the current management structure, permanent appointments need to be made for both managers and sufficient social workers within the service. Inspectors were told that plans to make such appointments are in place. The service needs to review the number of staff required to continue both to recruit sufficient carers, and provide adequate levels of supervision and annual reviews. In order to maintain the developments that have taken place since the last inspection and undertake future service developments.

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EVIDENCE:

There was evidence of monitoring of quality standards within the service and managers showed good leadership of the service. Staff and carers said that they felt some significant improvements had taken place, regarding the management of the service, and a greater sense of purpose and achievement was evident across the service. This was reflected in good quality supervision, target setting and appraisal of both staff and managers. It is recommended

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EVIDENCE:

Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 21 that the audit trail for the quality assurance system be strengthened to ensure that all documents are signed and any recommendations are evidenced as having been followed up by managers.

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EVIDENCE:

A new training programme has been recently introduced for carers and this is being linked to a new payment scheme for cares that will link payments to carers to skills and competencies. Previous training opportunities for carers have been limited and the new programme will take some time to provide sufficient post approval training for carers and staff, this therefore can only be assessed as adequate at this stage.

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EVIDENCE:

Children’s case records are now held electronically, those looked at held all of the information required, however the sample was extremely small due to the limitations of time allowed for the inspection. Inspectors were told the fostering service is intending to transfer all of its records to electronic systems in the near future. Of the paper files held, some entries were not signed and dated and some records lacked specific detail, despite evidence of file audits these omissions, had not all been identified.

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EVIDENCE:

A further recommendation is made that foster carer agreements contain specific details regarding the mandatory training requirements for foster carers.

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EVIDENCE:

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SCORING OF OUTCOMES

This page summarises the assessment of the extent to which the National Minimum Standards for Fostering Services have been met and uses the following scale.

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SCORING OF OUTCOMES

4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable

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SCORING OF OUTCOMES

BEING HEALTHY ACHIEVING ECONOMIC Standard No Score WELLBEING 12 3 Standard No Score 14 2 STAYING SAFE 29 2 Standard No 3 3 MANAGEMENT 6 3 Standard No Score 8 3 1 3 9 1 2 3 15 2 4 2 30 3 5 3 16 3 ENJOYING AND ACHIEVING 17 2 Standard No Score 18 3 7 3 19 3 13 3 20 3 31 3 21 3 22 3 MAKING A POSITIVE 23 2 CONTRIBUTION 24 3 Standard No Score 25 3 10 3 26 X 11 2 27 X 28 3 32 3

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SCORING OF OUTCOMES

Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection?

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STATUTORY REQUIREMENTS

This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Fostering Services Regulations 2002 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales.

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STATUTORY REQUIREMENTS

No. Standard Regulation Requirement Timescale for action 1. FS9 12 Foster carers must be provided with full information regarding the child prior to the commencement of the placement unless in the case of emergency when this must be obtained as a matter of priority 01/06/07

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RECOMMENDATIONS

These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out.

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RECOMMENDATIONS

No. Refer to Standard Good Practice Recommendations

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RECOMMENDATIONS

1. FS15 The service provider should ensure that all staff files hold documentary evidence that all information required to be held, including a photograph, evidence of GSCC registration where required and CRB checks be retained until first inspected by the regulatory body. 2. FS14 The service provider should strengthen to training provided to carers in the need to prepare young people for living independently 3 FS29 The service provider should ensure that all transport costs are identified as part of the placement planning process.

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RECOMMENDATIONS

Plymouth City Council Local Authority Fostering Agency SC_SC055714_20070115.doc Version 5.2 Page 24 4 FS4 The service should ensure that all entries in records are signed and dated by the author. 5 FS17 The service provider should ensure that it reviews the number of staff required in order to fully meet the needs of the service. 6 FS23 The service provider should provide foster carers with specific details regarding mandatory foster carer training in the foster carer agreement. 7. FS11 It is recommended that the service improves consultation with young people and their families by introducing feedback questionnaires at the ending of each placement.

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RECOMMENDATIONS

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Commission for Social Care Inspection

Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP

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Commission for Social Care Inspection

National Enquiry Line Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI

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