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Chapter 1
Framework for the Child and Family Services Reviews

The Federal Child and Family Services Reviews (CFSRs) are quality assurance reviews of State child welfare policy and practice. The reviews focus on how well States perform in achieving positive outcomes in the following three domains for children and families engaged in child welfare services: safety, permanency, and child and family well-being. The Children's Bureau Central and Regional Office staff work in conjunction to provide guidance to State agency staff as they plan for and participate in this Federal review.

The reviews have been administered by the Children's Bureau, Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS), since 2000. On January 25, 2000, the HHS published a final rule in the Federal Register to establish the new review system. The final rule, which became effective March 27, 2000, is available on the Children's Bureau Web site at http://www.acf.hhs.gov/programs/cb.

This chapter describes the purpose and history of the reviews; the central principles and concepts on which the reviews are based; the overall review structure, including the two phases of the reviews and the Program Improvement Plan (PIP) process; and the steps in the review process. Each phase of the review and the PIP process is described in more detail in subsequent chapters.

A. Purpose of the Reviews

The 1994 Amendments to the Social Security Act (SSA) authorized the HHS to review State child and family services programs to ensure substantial conformity with the State plan requirements in titles IV-B and IV-E of the SSA. Title IV-B of the SSA and 45 Code of Federal Regulations (CFR) §1357.15 require States to submit Child and Family Services Plans (CFSPs), that is, State title IV-B plans, to the ACF. Through the CFSRs, review teams assess child protective services, foster care, adoption, family preservation and family support, and independent living services. States found to be out of substantial conformity with the requirements must engage in a program improvement process, and technical assistance (TA) is available to assist States in addressing areas needing improvement.

In addition to reviewing for States' substantial conformity with applicable requirements, the CFSRs are designed to help States improve child welfare services and the outcomes for children and families who receive services. The review team identifies strengths of State programs and areas needing improvement. Other purposes of the reviews include:

• Ensuring that Federal funds are spent in accordance with Federal statute, regulation, and policy
  
  
• Linking the CFSRs to existing Children's Bureau Regional Offices and State joint planning, TA, and program improvement processes
  
  
• Assisting States in becoming self-evaluating over time
  
  
• Collecting data that will inform national policy
  
  
• Providing timely and specific feedback to States that is directly related to program performance and outcomes

B. Conceptual Framework of the Reviews

The CFSRs are based on the following central principles and concepts:

• The CFSRs are a collaborative effort between the Federal and State governments. A Federal and State Review Team conducts the reviews and evaluates State performance. Typically, two teams (with some overlapping membership) conduct the review: (1) a Statewide Assessment Team, made up of State child welfare agency staff and external partners, and (2) an Onsite Review Team, made up of both Federal and State staff and their representatives. A PIP Development Team, made up of State child welfare agency staff and external partners, manages the PIP process, as needed. (Chapter 2 provides more information about each team.)
  
  
• The CFSRs are designed to examine State programs from two perspectives. First, the reviews assess the outcomes of services provided to children and families. Second, they examine systemic factors that affect the ability of State agencies to help children and families achieve positive outcomes.
  
  
• The review team collects information from a variety of sources in making decisions about a State's performance. These sources include a Statewide Assessment, completed by the Statewide Assessment Team; case records and case-related interviews with children, parents, foster parents, caseworkers, and other professionals knowledgeable about the cases; data indicators; and interviews with State and local stakeholders.
  
  
• Through the reviews, the Children's Bureau promotes States' use of practice principles believed to support positive outcomes for children and families. These are family-centered practice, community-based services, individualizing services that address the unique needs of children and families, and strengthening parents' capacity to protect and provide for their children.
  
  
• The CFSRs are designed to capture both State program strengths and areas needing improvement. The reviews include a program improvement process that States use to make improvements, where needed, and build on identified State strengths.
  
  
• The CFSRs promote State development of PIPs designed to strengthen States' capacity to create positive outcomes for children and families.
  
  
• The CFSRs emphasize accountability. While the review process includes opportunities for States to make program improvements before having Federal funds withheld for nonconformity, significant penalties are associated with the failure to make the improvements needed to achieve substantial conformity.
  
  
• The CFSRs promote ongoing State self-evaluation of programs and outcomes.

C. Collaborating During the Reviews

The CFSRs require a collaborative process that focuses on identifying shared goals and activities and establishing a purpose, framework, and plan for improving child welfare services. Most importantly, this collaborative process should result in changes that promote improved outcomes for children and families. The overarching principles guiding the CFSR collaborative process include:

• The safety, permanency, and well-being of children is a shared responsibility, and child welfare agencies should make every effort to reach out to other partners in the State who can help to achieve positive results with respect to the CFSR child welfare outcomes and systemic factors. (See Chapter 2 for examples of partners that may be included in the review process.)
  
  
• Child welfare agencies do not serve children and families in isolation. They should work in partnership with policymakers, community leaders, and other public and private agencies to improve outcomes for children and families in their States. This includes partnering with organizations that directly serve children, youth, and families, and those whose actions impact family and community life.
  
  
• Family-centered and community-based practices are integral to improving outcomes for children and families. As such, collaboration with families, including young people, is important in identifying and assessing strengths and barriers to improved outcomes for children, youth, and families.

Real collaboration has a purpose and a goal; it takes time and effort to promote meaningful collaboration. There also are varying degrees of collaboration, each of which can serve the CFSR process and, more importantly, children, youth, and families. (See Appendix J, Collaborating During the Child and Family Services Reviews, for more information on collaboration.)

D. Structure of the Reviews

The CFSRs comprise two phases: the Statewide Assessment, which the State completes in the 6 months before the onsite review, and the onsite review:

• In the first phase, the Statewide Assessment Team completes a Statewide Assessment, using data indicators to evaluate the programs under review and examine the systemic factors subject to review. (Chapters 2 and 3 provide more information about the Statewide Assessment Team and the Statewide Assessment, respectively.)
  
  
• In the second phase, the Onsite Review Team examines outcomes for a sample of children and families served by the State during a specific period (known as the period under review) by:
  • Conducting case record reviews and case-related interviews to assess the quality of services provided in a range of areas.
    
    
  • Conducting State and local stakeholder interviews regarding the systemic factors that affect the quality of those services (Chapters 2 and 4 provide more information about the Onsite Review Team and the onsite review, respectively.)

(For more information on the period under review, see Child and Family Services Review Technical Bulletin #2 (for reviews occurring in fiscal years 2007-2010) on the Children's Bureau Web site at http://www.acf.hhs.gov/programs/cb.)

A State determined not to be in substantial conformity with one or more of the seven outcomes or seven systemic factors under review then develops a PIP that addresses all areas of nonconformity. The State submits the PIP to the Children's Bureau Regional Office for approval within 90 calendar days of receiving the written notice of nonconformity. (The Final Report on the review serves as written notice of nonconformity. A courtesy copy of the report is provided to the State within 30 days of completion of the onsite review. See chapter 6.) The State then implements the approved PIP, including receiving TA as outlined in the plan. The Children's Bureau Regional Office monitors the plan's implementation and the State's progress toward PIP-specified goals. (Chapter 7 provides more information about the PIP.)

During both review phases and the PIP process, if necessary, States have access to TA provided by the Children's Bureau-funded National Resource Centers and coordinated through the Children's Bureau Regional Offices.

D.1. Outcomes and Systemic Factors

In the two phases of the CFSR, the review team assesses seven outcomes of child welfare services provided to children and families and seven systemic factors that affect the quality of those services. The information that the review team collects on the outcomes and systemic factors contributes to the overall determination regarding the State's substantial conformity.

D.1.1. Assessment of Outcomes

During the Statewide Assessment and onsite review, the review team assesses the following seven outcomes in three domains, safety, permanency, and child and family well-being, by examining 23 items:

• Safety Outcome 1: Children are, first and foremost, protected from abuse and neglect.
  
  
• Safety Outcome 2: Children are safely maintained in their homes whenever possible and appropriate.
  
  
• Permanency Outcome 1: Children have permanency and stability in their living situations.
  
  
• Permanency Outcome 2: The continuity of family relationships and connections is preserved for children.
  
  
• Child and Family Well-Being Outcome 1: Families have enhanced capacity to provide for their children's needs.
  
  
• Child and Family Well-Being Outcome 2: Children receive appropriate services to meet their educational needs.
  
  
• Child and Family Well-Being Outcome 3: Children receive adequate services to meet their physical and mental health needs.

For Safety Outcome 2, Permanency Outcome 2, and the three Child and Family Well-Being outcomes, the qualitative information about the items related to each outcome, collected through the onsite case record reviews and case-related interviews, is used to determine substantial conformity (the percentage of cases reviewed in which the outcomes were determined to be substantially achieved).

Safety Outcome 1 and Permanency Outcome 1 are rated using the following set of performance indicators:

• Qualitative information about the items related to each outcome, collected through the onsite case record reviews and case-related interviews (the percentage of cases reviewed in which the outcomes were determined to be substantially achieved)
  
  
• Data indicators obtained from the Adoption and Foster Care Analysis and Reporting System (AFCARS) and the National Child Abuse and Neglect Data System (NCANDS) (the State's performance on the data indicators for which national standards have been established, as noted in the Statewide Assessment)

For example, in evaluating Safety Outcome 1, "Children are, first and foremost, protected from abuse and neglect," the reviewers examine the following items and data indicators:

• Items
  • Item 1: Timeliness of initiating investigations of reports of child maltreatment
    
    
  • Item 2: Repeat maltreatment
• Data Indicators
  • Absence of maltreatment
    
    
  • Absence of child abuse and/or neglect in foster care

(See Appendix B, Index of Outcomes and Systemic Factors, and Associated Items and Data Indicators, which provides a complete list of the performance indicators applicable to each outcome and systemic factor. See chapter 5 for more information on the national standards and determining substantial conformity.)

D.1.2. Assessment of Systemic Factors

The review team also assesses the following seven systemic factors that affect outcomes for children and families by examining 22 items (see Appendix B, Index of Outcomes and Systemic Factors, and Associated Items and Data Indicators):

• Statewide information system
  
  
• Case review system
  
  
• Quality assurance system
  
  
• Staff and provider training
  
  
• Service array and resource development
  
  
• Agency responsiveness to the community
  
  
• Foster and adoptive parent licensing, recruitment, and retention

During the Statewide Assessment phase, States examine a set of CFSP and other program requirements for each of the systemic factors. During the onsite review, the Team Leaders and Local Site Leaders interview selected State and community stakeholders to determine how well each systemic factor functions. Decisions about a State's substantial conformity with the systemic factors are based on whether these are in place and functioning satisfactorily. (See chapter 5 for more information on determining substantial conformity.)

For a complete list of the items that are considered under each of the systemic factors, see Appendix B, Index of Outcomes and Systemic Factors, and Associated Items and Data Indicators.

E. Steps in the Review Process

The steps in the review process described below are conducted by the Children's Bureau Central and Regional Offices, the State, or a Federal contractor, or are a shared responsibility. (More detail on key steps is provided in chapters 3-7 of the manual. In addition, see Appendix C, Timeframes for CFSR Activities, for a summary of the timeframes for the major CFSR activities.)

• Determine the dates for the review. The Children's Bureau Central and Regional Offices determine the dates for the review, in collaboration with State child welfare agency officials. Reviews must be conducted within the timeframes specified in 45 CFR §1355.32.
  
  
• Form the review team. The review team comprises both Federal and State representatives. Federal representatives, selected by Federal staff, include Children's Bureau Central and Regional Office staff and trained consultants. The State selects members for its Statewide Assessment Team, Onsite Review Team, and PIP Development Team. (See chapter 2 for more information on the teams.) The State teams include State agency staff and external partners, such as individuals who participate in developing the State's CFSP.
  
  
• Conduct planning conference calls. The Children's Bureau Central and Regional Office staff conduct a series of review planning conference calls with each State (formal review planning calls are held with each State to discuss State data issues, the Statewide Assessment, and onsite review planning functions; the Children's Bureau staff also host additional calls with the State, as needed).
  
  
• Transmit data profiles, selected from AFCARS and NCANDS, to the State. To reduce the burden on the State, the Federal Government compiles data submitted by the State to AFCARS and NCANDS into safety and permanency data profiles that the State uses in completing its Statewide Assessment. For the initial review only, States were permitted to provide an alternate source of data in lieu of AFCARS data. For the initial and subsequent reviews, a State may provide an alternate source of data in lieu of NCANDS data.
  
  
• Complete the Statewide Assessment. The Statewide Assessment provides the State an opportunity to examine data indicators and other information, such as the input of a variety of stakeholders, regarding its programmatic goals and outcomes for children and families. The Statewide Assessment Team conducts the Statewide Assessment, with the support of the Children's Bureau Regional Office. The team comprises representatives of the State child welfare agency and their external partners, such as the courts; tribes; mental health, health, and education agencies; and others involved in the State's CFSP process. The Statewide Assessment is a primary source of information for determining substantial conformity with regard to the systemic factors under review. (The Statewide Assessment Instrument is available on the Children's Bureau Web site at www.acf.hhs.gov/programs/cb.)
  
  
• Designate sites for the onsite review activities. The Children's Bureau Central and Regional Office staff, and the State's Statewide Assessment Team jointly identify three sites in the State where the onsite review activities will occur. The State's largest metropolitan subdivision is a required site, and the other two sites are determined on the basis of information in the Statewide Assessment. (See chapter 3, section D.1., for more information on selecting sites for the review.)
  
  
• Select the sample and types of cases to be reviewed on site. The exact number of cases to be reviewed, by location and type of case (in-home services and foster care cases), is determined jointly by the Children's Bureau Central and Regional Offices, and the State, on the basis of information in the Statewide Assessment. (See chapter 4, section C, for more information on case selection and review.)
  
  
• Prepare and disseminate the Preliminary Assessment. The Children's Bureau Regional Office prepares an analysis of the Statewide Assessment on the Summary of Findings Form; this constitutes the Preliminary Assessment. The Children's Bureau Regional Office provides the Preliminary Assessment to the Child Welfare Review Projects¹ for distribution to all members of the Onsite Review Team before the onsite review. (The Summary of Findings Form is available on the Children's Bureau Web site at www.acf.hhs.gov/programs/cb.)
  
  
• Prepare for the onsite review. The State selects the 65 cases for the onsite review from a sample of in-home services cases and foster care cases randomly identified by the Children's Bureau. The State, in collaboration with the Children's Bureau Regional Office, also schedules case-related interviews and State and local stakeholder interviews, prepares reviewer schedules, and plans logistical arrangements; for example, hotels and transportation for State Review Team members and space for meetings and review activities. The Children's Bureau Regional Office collaborates with the Children's Bureau Central Office, the State, and the Child Welfare Review Projects to ensure that all review-related preparation is completed. The Children's Bureau Regional Office, for example, works with: (1) the Children's Bureau Central Office to approve the site selection, (2) the State to assign reviewers to the local sites, and (3) the Child Welfare Review Projects to provide training about the onsite review to the State Review Team and distribute review-related materials before the onsite review.
  
  
• Conduct the onsite review. The onsite review comprises case record reviews; case-related interviews with children, parents, foster parents, caseworkers, and other professionals knowledgeable about the cases; and interviews with State and local stakeholders and agency officials. It is completed in 1 work week by the Onsite Review Team.
  
  
• Complete and issue the Final Report. The Children's Bureau Regional Office, working with the Federal contractor responsible for preparing the initial draft of the report of the review, completes and distributes the report, which includes the written notice regarding substantial conformity. The report is distributed within 30 calendar days of the onsite review or 30 calendar days of resolving any discrepancies between the findings of the onsite review and the Statewide Assessment.
  
  
• Develop the PIP, as necessary. Within 90 calendar days of receiving written notice regarding substantial conformity, the State, in collaboration with its external partners, the Children's Bureau Regional Office, and the Children's Bureau-funded National Resource Centers, develops a PIP that addresses all areas of nonconformity, as determined through the review, and submits the plan to the Children's Bureau Regional Office for approval. The Children's Bureau Regional Office works closely with the State to produce a draft PIP for initial review within 30-60 days, when possible; this helps the State to finalize the PIP for ACF approval within 90 days.
  
  
• Implement the PIP. The State implements the approved PIP, TA is provided through the sources identified in the plan, and the Children's Bureau Regional Office monitors implementation of the plan through quarterly reports and other methods addressed in the plan.
  
  
• Withhold Federal funds for nonconformity. If the State fails to make the improvements in the approved PIP within the timeframe specified in the PIP, or does not submit a PIP, Federal funds are withheld from the State commensurate with the level of nonconformity.
  
  
• Conduct subsequent reviews. A State found to be operating in substantial conformity with all seven outcomes and seven systemic factors during a review must undergo a full review every 5 years and submit a completed Statewide Assessment to the Children's Bureau Regional Office 3 years after the onsite review. A State found not to be operating in substantial conformity on one or more outcomes or systemic factors during a review is required to undergo a full review 2 years after PIP approval.

¹ The Child Welfare Review Projects support the Children's Bureau in administering CFSRs. back

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