Findings

This section provides the major findings resulting from the review of the State's AFCARS data collection. Tab A provides detailed information on the findings for the general AFCARS requirements, each of the foster care and adoption data elements, and the case file review. The AFCARS data used for the review was from the report period April 1, 2003 through September 30, 2003 (2003B).

Overall, the State's information system design meets the AFCARS reporting requirements¹ . While there were several elements rated a “2” due to needed changes in the extraction of the data, many of these elements are part of the same “group” and the corrections will address all elements in each group. For instance, of the 103 AFCARS data elements there are 15 elements regarding “circumstances associated with removal” and ten elements associated with disabilities. Also, there are several areas where the State will need to focus on the quality of the data, for elements rated both a “2” and a “3.”

As part of the post-site visit analysis, the State's documents, the data, the case file review findings, team member notes, and corrections to the program code submitted by the State are assessed to make the final determination of findings. As a result, the original rating factors were modified from those given at the end of the on-site review. The findings matrix in Tab A reports the previous rating with a “strike-through” mark on it, and the new rating. The AFCARS Improvement Plan in Tab B contains the final rating factor.

General Requirements

Population Standards

The State is in full compliance with the adoption population requirements. In regard to the foster care population, the State is not including the complete foster care population required under AFCARS. The standards for the AFCARS foster care population require that the State include all children in foster care for whom the agency has responsibility for placement, care, or supervision (45 CFR 1355.40(a)(2)). The State does not include in the foster care reporting population children placed with relatives. This was identified during the State's Child and Family Services Review (CFSR). The State was in the process of making corrections at the time of the on-site AAR. The State provided ACF with a copy of the draft changes for review and comment. ACF reviewed the draft changes and provided feedback to the State. The State implemented the changes on July 1, 2004. The State staff needs to send the revised extraction code to ACF as part of the AFCARS improvement phase.

There was another error in the foster care reporting population related to the reporting of children placed for adoption through a private agency. These are children that are determined to have special needs and the State is paying a subsidy payment to the family prior to the finalization of adoption. These children are not in the agency's responsibility for placement, care or supervision and therefore, should not be included in the foster care file. They are only to be reported in the adoption file. A relatively small number of cases are involved, which will have a minimal impact on the total number of children reported in the foster care file.

Technical Requirements

The State was not using the transaction dates associated with the date of removal and the date of discharge to extract the data file. This resulted in fluctuations in the number of children being reported in AFCARS each report period. The State staff corrected the program code, which is reflected in the June 25, 2004 revisions. ACF will monitor the submission of data for two to three report periods to check for any fluctuations in the data.

Data Element

Information on Children Diagnosed with Disabilities (foster care elements #10 - 15; adoption elements #11 - 15, if the primary basis for special needs is a medical/emotional condition)

The State staff indicated that this information is underreported for the foster care file. For the report period under review, the number of responses for “yes” were 2,880 (35%), 5,411 (65%) for “no,” and zero for “not yet determined.” In the foster care file AFCARS contains the question “Has the child been clinically diagnosed as having a disability(ies)?” The State's information system, Family and Children's Services (FACS), does not have this question. Instead, there is a screen with a field for the worker to indicate with an “X” whether any of the listed categories of diagnosed disabilities apply. The response to the question on diagnosed disabilities is derived from these fields. So, if a disability is checked, the response to the question is “yes.” Otherwise, the response is coded as “no,” possibly creating a false “no” in the reported data. A blank in any of the fields could mean the child has not been seen by a physician, that the worker has not received the doctor's report, or the chil d had been seen by a doctor and has no medical needs. The responses in AFCARS have specific definitions:

“Yes” indicates that a qualified professional has clinically diagnosed the child as having at least one of the disabilities listed below.

“No” indicates that a qualified professional has conducted a clinical assessment of the child and has determined that the child has no disabilities.

“Not Yet Determined” indicates that a clinical assessment of the child by a qualified professional has not been conducted.

The State staff did an extensive amount of work mapping the International Classification of Diseases (ICD) codes to AFCARS. However, many of these codes are not appropriate for AFCARS purposes. The State submitted a revised listing of the codes that are mapped to the AFCARS category “emotionally disturbed.” The Children's Bureau reviewed this document and provided comments to the State.

Total number of removals from home and the date of discharge from a prior removal episode (foster care elements #19 and 20)

There is a problem with how the program code determines the number of previous removals, the date of discharge from a prior removal episode, and the discharge reason for the current removal episode. Currently, the program code assesses a limited number of discharge reasons when it calculates the number of removals and the discharge date of the prior removal episode. It checks for a “placement exit date” with an exit reason of “return home,” “transfer custody to other parent;” or “placement with suitable person.” The State is also incorrectly mapping some of its discharge reasons to AFCARS. The State has corrected most of the mapping errors for the reasons for discharge from the current removal episode. Also, some of the errors in these elements are related to the way the State was treating records of children placed with relatives. Once these changes have been fully implemented the data should better reflect what is occurring in Iowa's foster care system.

Placement Information (foster care elements #23 and 41).

There were several issues relating to the collection and reporting of placement information. As noted previously in the population section, the State does not report non-paid relative placements. As of July 1, 2004, the State will implement a new “out of home placement” screen. This will capture information on children placed with relatives. The State has provided ACF with a copy of the planned screen.

The State still needs to update the program code to ensure that the “date of current placement” reflects the date the child ran away or was placed in his/her own home while still in the agency's responsibility for care, placement or supervision (placement setting “trial home visit”). Also, since the program code does not check the information for the foster care provider, new dates of placement are inappropriately reported when there is a change in the status of a provider (i.e., if a provider becomes a pre-adoptive home). Also, the placement count should not include a return to the same placement setting from a “runaway,” “trial home visit,” or “acute stay hospitalization.”

The State is mapping all shelter care placements to “group home,” regardless of the size of the facility. Some of these facilities may house 12 children or more. Any facility with more than 12 children must be mapped to “institution.”

Circumstances associated with removal (foster care elements #26 - 40)

The State systems staff has completed some of the required changes needed for these elements. The remaining changes relate to modifications to the program code to redirect where it extracts the data and to “freeze” the data at the time it was entered, or within a reasonable timeframe afterwards. Currently, the “circumstances associated with removal” are extracted from three different screens and the data can be updated at any time after the child is in foster care. The data should reflect the circumstances known to the case worker that contributed to the reason the child was removed from his/her home. Once the State completes the system changes, supervisors should monitor the data to ensure workers are selecting all of the applicable circumstances.

Case plan goal (foster care element #43)

The frequency report indicates there are 2,746 (33%) of the records with a case plan goal “not yet established.” This seemed to be a high number of records with no case plan goal. This was supported by the case file analysis. There were several errors where the AFCARS report indicated “not yet established” and the child was in foster care for more than 60 days, some for more than a year. This may be partially due to where the program code extracts the information. The State and Federal teams agreed that the screen being used is not the most appropriate one. The State agreed to review the work flow for the entry of this information and make corrections accordingly. Also, the State is considering adding an alert to remind workers close to 60 days after the child enters foster care that a case plan goal must be established.

Another issue identified in the case file review indicates that workers may not be updating the case plan goal in a timely manner. There were records where the case plan goal should have been “long-term foster care” not “guardianship” or “reunify.”

Has the agency determined special needs and the primary basis for special needs (adoption element #9 and 10)

There was a significant discrepancy in the frequency report between the response of “yes” for this element and the response of “yes” for adoption element #35, which deals with whether an adoption subsidy exists. The numbers for element #35 were much higher than those in elements nine and ten. There is a default mapping missing data to “no.” The default needs to be removed and the State needs to ensure that workers enter the information regarding the primary basis for special needs.

Relationship of child to adoptive parents (adoption elements #29 - 32)

In the adoption file, the State is to report the relationship of the child to the adoptive parent(s). AFCARS allows for the reporting of more than one relationship. The State collects this data but it may be underreported in regard to multiple relationships. The system allows the worker to select only one relationship (step-parent, foster parent, other relative or other non-relative) of the adoptive parent to the child. For instance, if the adoptive parent was a relative and had been a foster parent, only one of the relationships is reported in AFCARS. This is resulting in an under-representation of the number of relatives and foster parents that are adopting children in Iowa.

Child was placed by [agency or person] (adoption element #34)

AFCARS asks for who or what agency placed the child for adoption - the public agency, a private agency, a tribal agency, an independent person, or the birth parent. The State is incorrectly reporting this information. The program code only extracts the response “public agency.” This is incorrect because the State also is involved in non-State agency adoptions. The State enters into adoption agreements with families adopting children from private agencies where the child was determined to have special needs. These records should indicate “placed by private agency” in the AFCARS report.

¹This does not mean that the State's system is in full compliance with the Statewide Automated Child Welfare Information System (SACWIS) requirements. Back

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