Chapter I. Assisting States in Attaining Positive Outcomes for Children and Families
A primary mission of the U.S. Department of Health and Human Services (the Department) is to ensure that essential human services are provided to those individuals in society who are least able to help themselves. Included in that population are the millions of children who come into contact with the Nation's child welfare service systems each year.
The Department is responsible for assisting States in the delivery of child welfare services that strengthen families and promote children's safety, permanency, and well-being. In carrying out this responsibility, the Department provides funding for and/or administers multiple grant programs and special program and training initiatives. In addition, the Department operates resource centers established to provide the field with information and technical assistance in the areas of child welfare programming, research findings, services, policies, and data-collection systems. (See appendix F for a description of the Department's child welfare-related resource centers.)
The Department's assistance to States in this area (through the Children's Bureau) is intended in large part to promote attainment of the following key outcomes:
- Children are protected from harm (safety);
- Children who must be removed from their families are returned home or placed with an appropriate permanent family as quickly as possible (permanency); and
- Children and families who come into contact with the child welfare system receive the supports and services necessary for positive growth and development (well-being).
The Department employs two mechanisms to determine the extent to which States are successful in attaining these outcomes and identify areas where assistance is needed. One mechanism is the Child Welfare Outcomes: Annual Report to Congress (Outcomes Report). As noted in the introduction, this initiative was developed in response to section 479(A) of the Social Security Act as added by section 203 (a) of the Adoption and Safe Families Act (ASFA) of 1997. ASFA required the Department to develop a set of child welfare outcome measures and to "Â…prepare and submit to the Congress a report on the performance of each State on each outcome measure, which shall examine the reasons for high performance and low performance and, where possible, make recommendations as to how State performance could be improved." The second mechanism is the Child and Family Services Review (CFSR), a comprehensive monitoring system first implemented in fiscal year (FY) 2001.
Although the Outcomes Reports and the CFSR represent separate activities within the Department, one objective of both initiatives is to provide information that the Department can use to assist States in improving child welfare services. The following sections provide a discussion of how each of these initiatives meets this objective.
How the Department Can Use Information from the Outcomes Reports To Assist States in Attaining Positive Outcomes for Children and Families
The Outcomes Reports provide annual data (starting in 1998) on each State's performance on the seven national child welfare outcomes and also present annual "context" data on each State's child welfare population. Based on information provided in the Outcomes Reports, a State and the Department can identify changes occurring in the performance on the outcomes over time. The Department can use these data to explore with a State the possible reasons for change in performance and then, if necessary, target assistance to meet that State's unique needs.
The Department also can use information from the Outcomes Reports to identify common concerns across States and develop policies and programs to address those concerns. Some examples of cross-State concerns that have been consistently identified in the Outcomes Reports are the following:
- In many States, substantial percentages of children who enter foster care at age 13 or older and children who have a diagnosed disability are not exiting foster care to a permanent home.
- Many States with a relatively high percentage of reunifications occurring within 12 months of the child's entry into foster care also have a relatively high percentage of children re-entering foster care within 12 months of a prior foster care episode.
- In many States, the majority of children who are exiting foster care to adoption have been in foster care for longer than 2 years.
In addition to identifying common concerns, the Outcomes Reports inform the Department and the field regarding general features of the Nation's public child welfare systems. The Department can use this information as a guide in developing policies and programs designed to enhance the capacity of States to improve outcomes for children and families. For example, although child maltreatment victims are generally perceived as being young children, data from prior Outcomes Reports demonstrate that in most States, at least 20 percent of the child victim population is age 12 or older at the time of the maltreatment substantiation. In many States, 25 percent of child victims are age 12 or older. This is important information because a response to child maltreatment that is effective for children younger than age 12 may not be effective for adolescents.
Finally, data from the Outcomes Reports demonstrate that State foster care populations differ extensively. The populations differ not only with regard to size, but also with regard to the characteristics of children in that population. For example, as reported in a prior Outcomes Report, there are a several States in which 20 percent of the children entering foster care in a given year were age 16 or older. The kinds of issues that these States confront regarding permanency and well-being for children in foster care will be quite different from those States in which only a very small percentage of children entering foster care in any given year are in that age group.
How the Department Can Use Information from the CFSR Findings To Assist States in Attaining Positive Outcomes for Children and Families
Although the CFSR and the Outcomes Reports have a common goal, a key difference between them is that the reports focus on quantitative data from national data-reporting systems, while the CFSR incorporates qualitative information pertaining to State child welfare agency functioning and casework practices. During a CFSR, information is obtained from the following sources:
- A report prepared by the State that provides the findings of the State's self-assessment conducted prior to the on-site review;
- A State Data Profile prepared by the Department using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) and the National Child Abuse and Neglect Data System (NCANDS);5 and
- An on-site review process that includes comprehensive reviews of 50 cases over 3 sites, and interviews or focus groups with parents, children (when appropriate), foster and adoptive parents, private service providers, child welfare agency caseworkers and supervisors, State and local child welfare agency administrators, and a range of other stakeholders at local and State levels.
The Department analyzes the information from these sources to determine whether a State is in substantial conformity with seven outcomes and seven systemic factors assessed through the CFSR (presented in appendix G). Substantial conformity means that the State has met Federal criteria established for each outcome and systemic factor.
In addition, the Department established national standards for 6 of the 12 national outcome measures developed for the Outcomes Reports (appendix H provides information relevant to development of the national standards). The CFSR uses a State's performance with respect to the national standards, along with information obtained from case reviews and stakeholder interviews, to determine the State's substantial conformity with particular outcomes. The following are the measures included in the Outcomes Reports for which national standards have been established for the CFSR.
-
Outcomes Report Measure 1.1 —Maltreatment
recurrence.
CFSR National Standard: Of all children who were victims of substantiated or indicated child abuse and/or neglect during the first 6 months of the period under review, 6.1 percent or fewer children had another substantiated or indicated report within 6 months of the first report. -
Outcomes Report Measure 2.1 —Incidence of child abuse
and/or neglect of children in foster care.
CFSR National Standard: Of all children in foster care in the State during the period under review, 0.57 percent or fewer were the subject of substantiated or indicated maltreatment by a foster parent or facility staff member. -
Outcomes Report Measure 4.1 —Exits from foster care to
reunification occurring in specified time periods.
CFSR National Standard: Of all children who were reunified with their parents or caretakers at the time of discharge from foster care, 76.2 percent or more were reunified in less than 12 months from the time of the latest removal from the home. -
Outcomes Report Measure 4.2 —Incidence of re-entry
into foster care.
CFSR National Standard: Of all children who entered foster care during the period under review, 8.6 percent or fewer reentered foster care within 12 months of a prior foster care episode. -
Outcomes Report Measure 5.1 —Exits from foster care to
a finalized adoption occurring within specified time
periods.
CFSR National Standard: Of all children who exited foster care to a finalized adoption during the year under review, 32 percent or more exited foster care in less than 24 months from the time of the latest removal from the home. -
Outcomes Report Measure 6.1 —Percent of children in
foster care for specified periods of time who experienced two or
fewer placement settings.
CFSR National Standard: Of all children who have been in foster care for less than 12 months from the time of the latest removal from the home, 86.7 percent or more have had no more than 2 placement settings.
The Department uses performance relative to these national standards, as well as information from case reviews and stakeholder interviews, to determine a State's substantial conformity with specific outcomes. The results of the CFSR are compiled into a final report that serves as a basis for a State's program-improvement plan, which is developed by the State in conjunction with the Department, and that targets those areas identified in the final report as needing improvement. During FY 2001 and FY 2002, 32 States participated in a CFSR. The remainder of the States will participate in the CFSR during FY 2003 (13 States) and FY 2004 (7 States). (The CFSR schedule is provided in appendix I.) In subsequent years, the schedule of the Department's reviews will be based on the completion dates of each State's program-improvement plan.
The program-improvement plan component of the CFSR reflects the Department's State-specific approach to assisting States in improving outcomes for children and families. However, information from the CFSR final reports indicates that many States confront similar problems and have common concerns. This suggests that in addition to State-specific efforts, the Department can use CFSR information to develop more broad-based approaches to assisting States.
Some examples of the common concerns identified from the analyses of CFSR findings for States participating in a CFSR during FY 2001 and FY 2002 are the following:
- No State achieved substantial conformity with outcomes pertaining to: (1) attaining permanency and stability for children in foster care, or (2) enhancing the capacity of families to provide for children's needs.
- In many States, the needs-assessment processes were found to be inadequate to ensure children's safety, permanency, and well-being because they did not capture potential underlying causes of child maltreatment, such as substance abuse, domestic violence, and mental illness; did not address all family members' needs; or were limited to assessing risk of harm only.
- In many States, the barriers to placement stability for foster care children included a lack of appropriate out-of-home placements for children and a tendency to rely on temporary shelter placements when children entered foster care and when children's placements were disrupted. Although a child's placement in a shelter may be necessary in some situations, frequent use of shelters as placement options increased placement instability.
- In many States, the CFSR identified court-related barriers to attaining permanency (particularly adoption) in a timely manner, such as delays in holding permanency hearings in the required timeframes, overcrowded court dockets, time-consuming appeals procedures (particularly when termination of parental rights is involved), and judges (as well as child welfare agency staff) who did not follow the timeframes for seeking termination of parental rights (TPR) (or providing compelling reasons for not seeking TPR) that were established by ASFA.
- In most States, child welfare agency practice was not consistent with regard to involving parents and children in the case-planning process.
- In many States, the frequency and quality of face-to-face contact between caseworkers and the children and parents in their caseloads often were not sufficient to meet the needs of the children or further the attainment of case goals.
- In many States, the child welfare agency was not consistent in monitoring the ongoing safety of children in cases in which children remain in the home while the family receives services.
These findings provide information to the Department and its network of resource centers regarding potential target areas for a broad-based approach to assisting States in achieving positive outcomes for children and families. The Department and its resource centers also can and have used cross-State information to design workshops to be presented at national and regional conferences and to develop papers and reports for national dissemination. Although these broader approaches are not intended to replace the State-specific assistance process, they enhance the Department's capacity to assist multiple States at the same time.
Integrating Information from the Outcomes Reports and the CFSR
The above discussions indicate that both the Outcomes Reports and the CFSR have significant implications for informing the Department (as well as the States and the field in general) about the kinds of assistance that States need to improve outcomes for children and families in the child welfare system. Taken together, they offer a broad picture of child welfare agency functioning at the State-specific and cross-State levels. The Outcomes Reports provide quantitative information about State child welfare systems and State status with regard to performance on the outcome measures. The CFSR provides more in-depth information about child welfare agency functioning with respect to case-level practices and perceptions of stakeholders.
In this Outcomes Report and in future reports, the Department will continue to assess the status of States with regard to performance on the outcome measures and report cross-State commonalities as well as differences. The following chapter provides the key findings pertaining to State performance on the national child welfare outcomes.
5 In some instances, when appropriate, the Department approved the use of alternative sources of data from the State for some of the data provided in the State Data Profile. This is permitted by regulation. back
