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 were from the report period October 1, 2004 - March 31, 2005.

As part of the post-site visit analysis, the State’s documents, the data, the case file review findings, and team member notes 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.

In general, the overall finding of the AFCARS review reflects the need for improved data quality. The State has technical corrections, but most of these are minor corrections to the extraction code. There are a few areas that require more work to correct and these are detailed in the section “Data Elements – Technical Errors.”

One significant finding is in the area of placements. The State indicated there are instances when a suitable foster home, or group home, are not immediately available when a child enters foster care. Consequently, the child may be placed in multiple foster homes for one night at a time. The staff acknowledged this was not acceptable practice and that the State is working to improve its ability to find suitable foster settings and to provide placement stability for a child. The staff also indicated that these placements are not reported in AFCARS because the State’s understanding was that a child’s placement in a location was to be at least 24 hours before it was to be included as a placement count in AFCARS. This is not an accurate interpretation of ACF policy and the State must include each of these placement settings and count them for AFCARS purposes. As noted in the policy clarification in the Child Welfare Policy Manual (CWPM), 1.2B.7 question #7, a placement is: “… the physical setting in which a child finds himself or herself…. A new placement setting results when the foster care setting changes, for example, when a child moves from one foster family home to another or to a group home or institution.” The question and answer that the State was referring to is in regard to how to count brief absences from an on-going foster care setting.

General Requirement Standards

The State was found to be in full compliance with the adoption population standards and the technical standards. The State is not in full compliance with two foster care population standards.

The AFCARS data are to include all children who are in the agency’s responsibility for placement, care, or supervision that are on “trial home visits” (Child Welfare Policy Manual, Section 1.3, AFCARS Reporting Population). The State’s program code that extracts the AFCARS data enters a discharge date and reason when a child returns home. The State explained this was done in order to ensure timely entry of the discharge date; thereby meeting the transaction date timeliness standard. However, in some instances judges may maintain the agency’s placement and care responsibility of the child. The State needs to include children returned home for the full specified period of time, including extensions beyond six months, while the agency maintains responsibility for care and placement of the child.

The State is including in its AFCARS report youth over the age of 18 that should not be included. The State’s age of majority is 18 and it claims title IV-E funds for individuals up to their 19 th birthday, if the child meets the IV-E requirements. The State also provides foster care services for youth over the age of 18 (up to the age of 22) with State funds under a voluntary agreement with the child. However, for AFCARS purposes, once a non IV-E eligible youth reaches the age of majority he/she must no longer be included in the AFCARS population. In Massachusetts, only 18-year olds that have been placed by the State and are title IV-E eligible are to be included in the AFCARS report. Otherwise, all youth that are still in a placement as of their 18 th birthday must be reported to AFCARS as discharged with a reason of “emancipation,” unless there is another appropriate outcome reason.

Data Elements - Technical Errors

Diagnosed disability information (Foster care element #10)

The State indicated that their practice/policy is for children to receive an initial basic exam by a doctor within seven days of entering foster care. Depending on the child’s age and health condition, a more complete physical is scheduled.

Based on the frequency report and the case file review, there appears to be an underreporting of this information. Of the 16,086 records reported for the 2005A report period, 2,196 (14%) were “yes,” 3,939 (24%) were “no,” and 9,951 (62%) were reported as “not yet determined.” Of the 54 records analyzed, there were 21 (38%) records with errors. Nine records had a response of “no” in AFCARS but the reviewer found applicable diagnosed conditions. In 12 records, the AFCARS response was “not yet determined.” All of these children had been in care for more than a year and in eight records, the response should have been “yes.”

One reason the numbers for “unable to determine” are so high is because the program code maps missing data to this field. The State must map missing data to blank.

The State’s system is designed to capture whether there is a medical/psychological condition, the type of condition, the start date, recovery date, and whether it is a diagnosed condition. If the option “diagnosed” is selected, then foster care element #10 is mapped to “yes.” Otherwise, the field is mapped to “no.” The State staff indicated modifications are planned for the collection of this data. The revised program code will also check for doctor visit dates. The State will need to evaluate this method further to ensure that once the evaluation reports are received from the medical personnel the data are entered and the record is updated. The State should consider a way to incorporate the question and the responses into an appropriate screen in the system. This would ensure that a response of “no” means “no.”

Placement Information (Foster care elements #23, 24, and 41)

As noted above, the significant finding regarding placement data is in regard to the exclusion of one night placement stays. The State needs to ensure that these placements are entered into FamilyNet and are reported to AFCARS. There are 220 records missing information for the current placement setting (foster care element #41) and 196 records missing data for the date of the current placement setting (foster care element #23). If a child is in foster care there must be data representing a placement. Case workers must be instructed to enter the date and location for all living arrangements.

The State indicated there are instances where the child may run away after the agency is given responsibility for care and placement, but before the child is actually placed in a foster care setting (for example, the child may run away from the court room). In these instances, the agency would report the placement setting as runaway, record the date the child ran away, and the placement count would be zero.

The State staff indicated that they cannot exclude “respites” as a placement setting and, therefore, are included in AFCARS and in the placement count. Respite stays are not to be reported in AFCARS and the State must not include them as a placement setting or in the placement count. There are codes for “respite” in the program code and mapping forms. The State needs to look at whether the respite codes are used and if not used comment them out. The State should also evaluate whether these codes can be used to exclude respites as a placement setting and to exclude them from the date of placement and the number of placements.

Also, the State needs to modify the program code to not include children that have a first placement in a hospital or locked facility. The removal date and the placement date would be when/if the child is moved to a foster home or other setting.

The State indicated that some of their group homes are larger than 12 beds and all group homes are mapped to the AFCARS value “group home” regardless of the size of the home. The State must map group homes that house between seven and twelve children to “group home” and those with more than 12 beds to “institution.”

Sources of Financial Support (foster care elements #59, #62 and #64)

Data is collected for AFCARS on whether title IV-E foster care maintenance, title IV-D child support, and Social Security Income (SSI) payments are made on behalf of the child during a six-month report period. The State is incorrectly reporting that a child is eligible for title IV-E and SSI and not that an actual payment was made on behalf of the child. The accurate reporting of the title IV-E information is important as this element serves as the basis for the sample drawn for the title IV-E foster care reviews.

In regard to child support payments, the State does not currently have an interface between FamilyNet and the child support information system. The State must complete this interface in order to be in compliance with the Statewide Automated Child Welfare Information System (SACWIS) requirements. In regard to reporting this data for AFCARS, the State is required to report it regardless of having an interface or not. Currently, the system will support the manual entry of the receipt of child support payments. However, the program code is not checking the correct field for existing payment information. The program code must be modified to check for this information and extract it for AFCARS reporting.

Relationship between an adopted child and his/her adoptive parents (adoption elements #29 - 32)

For AFCARS purposes the State is to report all of the relationships that apply between the child and the adoptive parents (e.g., the adoptive parents are relatives and were foster parents). Currently, the State only reports one type of relationship.

The State is also including “fictive kin” in its definition of “relatives.” This is not correct. Only individuals that are related to the child by blood or marriage are to be included as relatives. The State must ensure that workers do not classify fictive kin as “relatives.”

Data Quality

Once the above elements are corrected the quality of the data will need to be assessed. In some instances, training regarding new fields or screens will have to be implemented. In addition to these elements, the quality of the data for an additional 22 foster care elements needs to improve. One way to address accuracy of the data is through additional training and supervisory oversight. The State needs to incorporate ongoing data quality assurance to ensure that the data are correct and consistent.

There are also issues that are probably related to data conversion. For the removal and placement information, most of the errors identified could be attributed to a lack of data entry when the State’s information system became operational. The State should encourage workers to clean up the removal and placement information on open cases in which there was a prior foster care history that occurred before use of the new information system.

Return to Table of Contents