Partners in Progress: Improving Outcomes through Systemic Change
Presentation by Joan Ohl at Annual Meeting of States and Tribes
I want to thank you all for coming here together in Washington for these few days to discuss one of the most important and visible initiatives that the Federal government has undertaken in recent years to improve child welfare services in the country - the Child and Family Services Review.
Last year, when many of you were here to discuss the reviews, we had completed reviews in the first 17 States. We have now reviewed 32 States and have approved 12 program improvement plans on our way to reviewing all States, plus the District of Columbia and Puerto Rico by early 2004. We have learned many very important lessons through this process, and this meeting provides us an opportunity to share what we have learned with you, and for you to share with us the knowledge and experience that you have gained thus far.
We have entitled this meeting "Partners in Progress," knowing that we all have critical roles in this tremendous effort. We are very fortunate to have here our partners from nearly all the State child welfare agencies, the country's largest cities, the tribes with whom we collaborate in this process, and our technical assistance providers from the National Resource Centers. We are all partners in this effort, and we must use our partnerships effectively if we are to see the progress in child welfare that we anticipate resulting from the Child and Family Service Reviews.
During the past two years, the attention of the entire field of child welfare has been drawn to the Child and Family Service Reviews because of the opportunity the reviews present to have such positive effects on the outcomes of child welfare services for children and families across the country. This effort also has the attention of Congress, which authorized the Department of Health and Human Services to re-vamp its methods for reviewing State child welfare programs in 1994, and continues to follow our progress in implementing the reviews. And, as many of you know quite well, the reviews have drawn the attention of the media as more and more States undergo reviews, and as information from the reviews becomes public knowledge.
While this attention to your work and to the findings of the reviews may create some anxieties for us, I believe that in the long run all of the attention is a good thing. It is good because, in a time when we routinely hear and read about so many tragedies that occur in child welfare programs across the country, we have this opportunity to demonstrate our commitment to evaluating ourselves critically and to making improvements where they are needed. It is good because we can use the reviews to acknowledge not only those parts of our programs that need improving, but also what we are doing right to serve children and families. And, finally, it is good because we have, through the CFSR, an opportunity to demonstrate that we can take on even the most challenging problems in child welfare when we work together as partners toward common goals.
We are at a crucial point in the Child and Family Service Review process. Until recently, our efforts have been primarily focused on gathering information through the reviews. Now, we must turn our attention to how we use that information to improve the ways we serve children and families through meaningful Program Improvement Plans. This is the most important part of the process. What you do now with the knowledge you have gained, and will gain, through this process will probably be the most important factor affecting the quality of child welfare services in the country for years to come. If we use the information only to make short-term fixes, while failing to address the underlying practice issues that affect the outcomes for children and families most directly, then we will surely not see the kind of results from this process that we are all hoping for. In fact, we know that there are no easy answers to the very complex issues facing child welfare.
Through the Program Improvement Planning process, we are looking for true systemic changes that will lead to lasting improvements in the way that we operate our programs. You will hear much about systemic change throughout this meeting, and that is what we are striving for as we move forward. By systemic change, I am referring to changes that target:
- the culture of child welfare agencies in the country,
- the values and beliefs that underlie the way we work with children and families,
- the ways in which we work together with our partners in each State who are so essential to the work we do,
- the capacity of our agencies to support good practice and positive outcomes, and most importantly,
- the day-to-day practice of child welfare in the field.
If we settle for anything less than this kind of change, we will not be taking full advantage of the opportunity before us, and we will not send the message to the public that we are indeed serious about reforming child welfare in this country. At the same time, we know that achieving systemic change in child welfare is neither quick nor easy.
We recognize that States throughout the country are facing budget shortfalls and tight resources on many fronts. Other factors, such as highly publicized child deaths and other tragedies affect the direction that States take in changing their programs. These factors make it all the more important to develop and use the partnerships that you have within your States to make the most of the resources and the talents that you have available.
I want to say a few words about the Program Improvement Plans that we have received to date. As I mentioned, we have approved 11 plans so far, and some of those plans offer much more promise for leading States to systemic changes than others.
We have seen a few plans that attempt to target the difficult practice issues that must be addressed if we are to see lasting changes in the practice of child welfare. For example, the draft Florida Program Improvement Plan emphasizes training supervisors and staff in the principles of family-centered practice, and re-directing front line caseworkers to focus on improved needs assessments of children and families, and using those assessments to develop meaningful case plans.
In another example, the approved Program Improvement Plan from the District of Columbia addresses the need to identify underlying contributors to child abuse and neglect and to provide appropriate services by creating multi-disciplinary teams within the agency that include specialists in areas such as domestic violence, substance abuse, housing, health services, and education. North Dakota proposes in its draft Program Improvement Plan to implement a wraparound service delivery model statewide collaboratively among the agencies responsible for child welfare, mental health, substance abuse, and private agencies in the State.
Those kinds of plans offer the hope of changing the way public child welfare agencies carry out their work with children, families, and communities to whom they are accountable. They are, however, are still more of the exception than the rule. Unfortunately, we are still receiving program improvement plans that merely scratch the surface in terms of the real improvements that must be made. For example, some of the plans that we receive seem to rely on simple policy changes or the adoption of a new instrument or tool in order to improve outcomes. Changing a policy will not change practice, and practice must change if we are to see measurable and lasting improvements in the outcomes for children and families.
Many of the Program Improvement Plans that we are receiving are basically "plans-to-plan" that will lead to nothing in two years, except another plan - as opposed to measurable improvements in the outcomes for children and families. When we identify critical issues in the review that affect child safety, permanency, and well-being, we cannot afford to lose a two-year Program Improvement Plan period doing further study of the issue at the expense of taking concrete action. The Program Improvement Plans must be "plans for action" and not "plans to plan" and they must target the underlying issues that affect the outcomes in each of your States.
We must also make greater efforts to develop approvable Program Improvement Plans in shorter periods of time than we are now taking. In a number of situations, many months are passing while we work develop strategies and work out the details of the plans. We still do not have approved plans for all of the first 17 States we reviewed in 2001, and we are now in 2003. The burden is on both the States and our ACF Regional Offices to see that planning begins early, that problems with the plans are resolved expeditiously, and that the focus of the plans is on the areas needing improvement as identified in the Child and Family Service Review. The long periods of time that we are now using to negotiate plans could be used to actually implement strategies to improve child safety, permanency, and well being.
States must use the opportunity that you have to consult with your partners during the statewide assessment phase of the review to explore the issues affecting the outcomes for children and families; to identify strategies for making needed improvements; and to engage your partners in a commitment to participate in the implementation of the plan. Beginning this collaboration early in the process, not just during the 90 days in which the State is attempting to develop a Program Improvement Plan, will help you to develop strong "plans of action" that include the knowledge, insight, and commitment of your partners.
As you move forward in developing and implementing your Program Improvement Plans, there are a few points that I would ask you to consider:
First, the Program Improvement Plan is not simply a deliverable product from the State to the Federal government. It is your statement to the rest of the country of how you plan to address areas needing improvement in your State's child welfare program. It is an opportunity for the States and their partners to develop, if they have not already done so, a renewed vision for their child welfare programs and for how services should be delivered. It is an opportunity to create, along with your partners in this process, both short-term strategies and long-term goals that will lead to improved outcomes for children and families. It is an opportunity to use the actual outcomes for children and families as the measures of your success, not merely whether you have put a new procedure or a new policy in place.
And, you should be aware that the Federal government is not the only entity that will monitor and evaluate the progress you make in implementing your plans. The public within your States, the families and children who you serve, the Congress, and the field of child welfare will all be watching to see if you can achieve positive changes in your child welfare programs through the Child and Family Service Review. Our joint efforts to evaluate child welfare programs in a more qualitative way than we've ever done before have raised both the suspicions and the expectations of the public and the field. They are suspicious about whether or not we can actually achieve meaningful change through this process, but they are also expecting us, collectively, to deliver on our intent to use the Child and Family Service Review to make the changes that are needed in the child welfare system. We in the Administration for Children and Families will view your Program Improvement Plans as your commitment to the children and families in your States, and I ask that you view them as nothing less.
The second point I would like you to consider is that in order to achieve any measure of success in this effort, you must work collaboratively with your "partners in progress" within your States. State child welfare agencies cannot create systemic change without the partnership of those other agencies, groups, and individuals that affect outcomes as much as the State or County child welfare agency. The Program Improvement Plan must be the product of those both within and outside the State child welfare agency whose participation, or lack of it, can make or break the plan.
As an example, when I review the final reports of each State's Child and Family Service Review, I am repeatedly struck by the challenges we face in achieving timely permanency for children in foster care. At the same time, I see over and again the difficulty that State agencies and the courts have in making the best use of the case review system, such as having timely and effective reviews, permanency hearings, and processes for termination of parental rights where that is appropriate. Almost every State here will need to address permanency issues in your Program Improvement Plans. And, each of you has before you the challenge of fully engaging your court systems in your Program Improvement Plans in order to have any measure of success in improving permanency outcomes for children in foster care.
As another example, I also often see in the final reports both the successes and the difficulties that State child welfare agencies and the tribes have in working collaboratively to meet the needs of Native American children and their families. In a number of States, the reviews have identified needs to work diligently to assure that tribal children coming to the attention of states are appropriately identified with notification to tribes, that we respect the placement preferences of tribal children, that we focus on achieving timely and appropriate permanency outcomes for Native American children in foster care, and that we find effective ways of engaging the tribes and Native American parents in decision-making about the outcomes for their children. As you develop Program Improvement Plans that address these critical areas, it is essential that States work in partnership with tribes to develop the goals and strategies that will have the best opportunity for success.
Similarly, almost all of you have faced tremendous challenges in meeting the mental health needs of children in your care and responsibility. This is often more difficult when substance abuse is a factor in the families you are serving. A common theme of the final reports I review is the lack of sufficient access to children's mental health services and to substance abuse treatment services. This is especially true in so many rural areas of your States, where access to services in general presents tremendous barriers to successful and timely outcomes for children and families. We have initiated efforts at the Federal level to help make more technical assistance in these areas available to States, and we have some of our new partners in this effort here with us during this meeting. I encourage you to bring your mental health and substance abuse partners to the planning table with you as you explore and develop strategies to make improvements in these areas.
These are just a few examples of the areas needing improvement where collaboration beyond the bounds of State child welfare agencies is not only desirable, but essential to achieving meaningful improvements. We have created an expectation that our partners will be involved in the Child and Family Service Review from the beginning, starting with the statewide assessment, and their active participation must continue through the planning and implementation of the Program Improvement Plans if you expect to achieve success in your efforts.
The third point I ask you to consider is that in order to achieve systemic change, your plans must address the day-to-day practice of child welfare in the field. We believe, and you must know, that the only way to have significant, measurable improvements in outcomes is to focus on what happens when caseworkers meet children and families in the field - the actual practice of child welfare.
You must examine your practices and policies to be sure that they are family centered and responsive to families' needs, and to do that you must have a clear understanding of what family centered practice means. You must look for ways to assure that you correctly assess the needs of the children and families you are charged to serve, and assure that the services you provide are the ones that address their identified needs. From reading the final reports, I know that this is one of the most challenging areas of practice for States to master and that all States reviewed to date will need to address this area in their Program Improvement Plans.
You must make greater efforts to engage families in planning for their needs. This includes fathers who are too often left out of our work with children and families.
You must assure that your staff have both the skills and the necessary supports to respond to families' needs. This involves not only training front-line staff but the supervisors who support and monitor their work.
You must work with your communities to help make services available when and where they are needed the most. We have tremendous resources in our communities to help us improve services, including an array of faith-based service providers eager to be our partners in this effort.
Changing practice in the field is one of the most difficult tasks of child welfare agencies, and also the cornerstone to any successful efforts that we make. Our network of National Resource Centers has made technical assistance in this area their priority as they work with States to develop and implement Program Improvement Plans.
We have also identified the need to use our Federal training funds to strengthen the professional education of BSW and MSW students so that they will be better prepared for work in public child welfare agencies. We believe that equipping new staff with the skills and knowledge they need to practice child welfare in a family-centered manner is essential, not only to attracting, retaining, and stabilizing the workforce in public child welfare agencies, but to improving the overall quality of our work. We still have a long way to go to realize the full benefits of the training opportunities that we support with Federal funds. Our continued focus on this area within the Federal government, along with State partnerships and collaboration with your educational institutions are essential elements to strengthening this critical area of staff training and education that affects every State in this room.
With the themes of "changing practice" and "increased partnership" underlying our meeting this week, we have focused much attention on critical practice issues and partnership efforts in the workshops we have planned for this meeting, and we want to work with you as you take on these difficult issues in your Program Improvement Plans. I applaud the efforts of those of you who have taken on the Child and Family Service Review as an opportunity to mobilize resources within the State and Federal government on behalf of your children and families. And, I want to challenge you to continue to use the child and family service review to make needed changes in your programs, to adopt processes for ongoing self-evaluation and collaboration that will help us all to look beyond mere compliance and what we "have" to do, to what we "can" do to improve the outcomes of our services to children and families.
This meeting is correctly titled "Partners in Progress" because we are indeed partners in this effort to improve our nation's child welfare system. We may not always agree on every issue, but I believe we can agree that partnership is essential to moving forward.