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Home > Statistics & Research > Child Welfare Outcomes 2002 > Chapter One

Chapter I. Achieving Positive Outcomes for Children

The Department of Health and Human Services (the Department) is the Federal agency responsible for implementing and/or monitoring programs and services that address the needs of children and families who come into contact with public child welfare systems. Within the Department, these responsibilities are carried out by the Children’s Bureau of the Administration on Children, Youth and Families within the Administration for Children and Families.

The primary responsibility of the Children’s Bureau is to assist States in the delivery of child welfare services that protect children and strengthen families. The Children’s Bureau provides grants to States, Tribes, and communities to operate a range of child welfare services, including child protective services (child abuse and neglect), family preservation and support, foster care, adoption, and independent living. In addition, the Children’s Bureau supports child welfare agency staff training, the development of new technology, and innovative programming through demonstration grants.

In recent years, a primary objective of the Department has been to monitor and enhance State capacity to achieve national outcomes pertaining to the safety, permanency, and well-being of children served by State child welfare systems. Two Department activities were undertaken within the Children’s Bureau to meet this objective. One activity is the Child Welfare Outcomes: Annual Report to Congress (Report to Congress). This activity assesses State performance on national outcomes based on data from two Federal national reporting systems—the National Child Abuse and Neglect Data System (NCANDS) and the Adoption and Foster Care Analysis and Reporting System (AFCARS). The second activity is the Child and Family Services Review (CFSR). The CFSR is the Department’s results-oriented, comprehensive, monitoring system first implemented in fiscal year (FY) 2001. It was developed in response to a mandate in the Social Security Amendments of 1994 for the Department to promulgate regulations for reviews of State child and family services programs under titles IV-B and IV-E of the Social Security Act. The CFSR uses a wide range of information sources to assess State performance, including NCANDS and AFCARS, intensive case reviews, interviews and focus groups with stakeholders in each State, and information provided by the States in a Self-Assessment Report. Although the Report to Congress and the CFSR are separate activities within the Department, they share the same overarching goal—to provide the Department and the States with information that can be used to enhance the safety, permanency, and well-being of all children who come into contact with the Nation’s child welfare systems. To accomplish this goal, the Department established outcomes and indicators for both the Report to Congress and the CFSR. The following sections of this chapter present these outcomes and indicators and the rationale for their selection.

Safety-Related Outcomes

According to Child Maltreatment 2002 (an annual report published by the Children’s Bureau that provides State and national child maltreatment data from NCANDS), an estimated 1.8 million referrals alleging child abuse or neglect were accepted by State and local child protective services (CPS) agencies for investigation or assessment. These referrals included more than 3 million children; approximately 896,000 of these children were determined by the CPS agencies to be victims of child abuse or neglect.6 The outcomes and indicators designed to assess State performance with regard to keeping these children safe are presented below for both the Report to Congress and the CFSR.

Safety outcomes in the Report to Congress

The Department, through the activities of the Children’s Bureau, supports many child maltreatment primary prevention efforts intended to assist families who have not yet come to the attention of public CPS agencies. However, the primary objective of the Children’s Bureau is to ensure that those children who are determined by CPS agencies to be victims of (or to be at high risk for) abuse or neglect are kept safe from further maltreatment, whether they are in their own homes or in an out-of-home placement. To address this concern, the Department established the following two safety-related outcomes for the Report to Congress.


Outcome 1 reflects the Department’s belief that the primary obligation of the public child welfare system is to implement policies, practices, and procedures that will protect children from continued abuse or neglect by a parent or primary caretaker. A State child welfare agency may protect children from continued harm by providing the children and parents with sufficient services to reduce the risk of harm to the children or, when this approach is clearly insufficient, by removing the child from the home. The measure developed for the Report to Congress as an indicator of outcome 1 is the following: Outcome measure 1.1—Of all children who were victims of substantiated or indicated child abuse and/or neglect during the first 6 months of the reporting period, what percentage had another substantiated or indicated report within a 6-month period?

The specific form of this outcome measure is a response to both the structure of the NCANDS data system and research findings regarding maltreatment recurrence. A 6-month time frame for maltreatment recurrence was established to ensure that the measure captured the actual incidence of maltreatment recurrence rather than estimating the incidence. In addition, multiple research findings indicate that the highest incidence of maltreatment recurrence tends to occur within 6 months of a prior incident. Therefore, the Department determined that the 6-month time frame was sufficient to assess State performance in this area.7

Outcome 2 reflects the Department’s belief that public child welfare agencies have an obligation to ensure that children placed by the State in out-of-home care do not become victims of abuse or neglect by the people responsible for their care—i.e., foster parents or facility staff members. Child welfare agencies ensure children’s safety in foster care through various practices and policies, including licensing procedures, training for foster parents and facility staff members, appropriate matching of children and placement resources, and the provision of supportive services to foster parents. The measure developed as an indicator for outcome 2 is the following: Outcome measure 2.1—Of all children who were in foster care during the reporting period, what percentage was the subject of substantiated or indicated maltreatment by a foster parent or facility staff member?

This measure is calculated from data reported to both NCANDS and AFCARS. States report data relevant to the number of children in foster care to AFCARS. Data pertaining to maltreatment by foster parents or facility staff members are reported to NCANDS. Recently, some concerns have been identified with regard to this measure that the Department is currently addressing by exploring clarification of who is to be included in the numerator and denominator for each State. For example, in some States, the children reported to NCANDS as maltreated in mental health or juvenile justice facilities are not reported to AFCARS because they are not included in the State’s foster care population. Therefore, all of the children represented in the numerator are not included in the denominator. In other States this is not a problem because these children are included in the State’s foster care population and therefore are reported to AFCARS as well as NCANDS.

Safety outcomes in the CFSR

The CFSR assesses State performance in keeping children safe based on data from the two safety-related outcome measures developed for the Report to Congress and information from intensive case reviews pertaining to the following safety-related outcomes:


The CFSR process determines whether States are in substantial conformity with these outcomes. A State is determined to be in substantial conformity with safety outcome 1 if the following criteria are met:


The national standards established for measures of maltreatment recurrence and maltreatment in foster care apply to the outcome measures developed for the Report to Congress. These standards are as follows:

A case was determined to have “substantially achieved” the CFSR safety outcome 1 when the case review process resulted in the following information8:

A determination of whether a case “substantially achieved” CFSR safety outcome 2 was based on the following case review information:

These indicators address two concerns with respect to child welfare practice. One concern is that children sometimes are removed from their homes in situations in which the provision of services to the family could have prevented the removal. The other concern is that children sometimes are left in their homes without sufficient services or monitoring to ensure their continued safety.

Taken together, information pertaining to State performance on the safety-related outcomes and indicators assessed through the Report to Congress and the CFSR provides a portrait of State effectiveness with regard to keeping children safe. The Report to Congress presents general findings relevant to statewide performance, while the CFSR adds an in depth understanding of case-level practices and agency policies and procedures.

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Achieving Permancy-Related Outcomes And Outcomes Relevant to Placement Stability And Appropriateness

The Adoption and Safe Families Act (ASFA) of 1997 emphasizes permanency as the primary goal for children in foster care, and provides guidelines for achieving this goal in a timely manner. A child may be said to have achieved a permanent home when the child is reunified with his or her family, when a finalized adoption has occurred, or when a legal guardian has been established for the child. The key concern reflected in ASFA is that children should not grow up in foster care. If it is necessary to remove children from their homes, reasonable efforts must be made either to return them to their families quickly and safely or to find another permanent home for them. A related concern underlying the Department’s approach to permanency is that when children are in foster care, they should be in placements that are stable and appropriate. The outcomes and measures established for the Report to Congress and the CFSR that are designed to assess permanency, placement stability, and placement appropriateness are presented below.

Permanency- and placement-related outcomes in the Report to Congress

For the Report to Congress, the Department established the following outcomes as reflecting State performance in achieving permanency for children in foster care.

State performance on these outcomes is calculated from data that States report to AFCARS. The Department established outcome 3 to assess State performance with regard to attaining permanent homes for all children in foster care and for specific subpopulations of children. The following measures were for outcome 3:

Outcome 4 is designed to ensure that children who are reunified with their families are reunified in a timely manner, but are not reunified “too soon”—i.e., before the conditions leading to the removal of the child are adequately addressed. The following measures were established to assess State performance on outcome 4:

The Department established outcome 5 to assess State performance in achieving adoptions in a timely manner. This outcome reflects the concern that there are children who are in foster care for long periods of time before adoption is actively pursued as a permanency goal. The result is that these children do not experience permanent homes through adoption in a timely manner.

The Department developed the following measure to assess performance on this outcome.

Outcome 6 reflects the Department’s belief that States have an obligation to ensure that children who are placed in foster care experience stability. The following outcome measure was developed to assess performance on this outcome.

Outcome 7 reflects the Department’s belief that a family foster home usually is the most appropriate foster care environment for young children. The measure developed for this outcome reflects a concern in the field that some young children are being placed in group homes or institutions rather than in family settings. The measure is the following.

Permanency- and placement-related outcomes in the CFSR

The CFSR assesses State performance with regard to achieving permanency and placement stability for children based on whether a State is in “substantial conformity” with the following outcomes:

A State may be found to be in substantial conformity with permanency outcome 1 if the following criteria are met:

The Department developed national standards relevant to this outcome that are derived from the Report to Congress outcome measures 4.1, 4.2, 5.1 and 6.1. These national standards are as follows.

The determination that a case “substantially achieved” permanency outcome 1 was based on the following information from the case review:

Permanency outcome 2 assesses State performance with regard to policies and practices that are believed to promote the attainment of permanency in a timely manner. A determination that a case had “substantially achieved” permanency outcome 2 was based on the efforts of the child welfare agency to meet the following criteria.9

The following chapters provide key findings with regard to State performance on the Report to Congress outcome measures. To enhance an understanding and interpretation of performance on these outcomes, chapter V also presents relevant information from the CFSR findings.

6 U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2002. Washington, D.C.: U.S. Government Printing Office, 2004. For Child Maltreatment 2002, a victim is defined as a child who was the subject of a substantiated or indicated maltreatment report, or whose maltreatment report has a disposition of "alternative response - victim." However, children considered as alternative response victims are not included in the calculation of the Report to Congress safety outcome measures. Back

7Fluke, J., Yuan, Y., & Edwards, M. (1999). Recurrence of maltreatment: An application of the National Child Abuse and Neglect Data System. Child Abuse and Neglect, 23(7), 633-650. DePanfilis, D., & Zuravin, S. (1998). Rates, patterns, and frequency of child maltreatment recurrences among families known to CPS. Child Maltreatment, 3(1), 27-42. Back

8The case review process includes reviews of case files and interviews with key individuals involved in the case, such as parents and children (if appropriate), caseworkers, supervisors, guardians ad item, and service providers. Back

9The determination of “substantial achievement” requires that a case meet three of these criteria if applicable given the circumstances of the child and family. Back

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